Total Laparoscopic Pancreaticoduodenectomy for Cancer

Thuan Nguyen, MD, Long Tran, MD, Bac Nguyen, MD, Tuan Le Quan, MD, Dat Le, MD

Division of Gastroenterologic and General Surgery, Department of Surgery, University Medical Center, Viet Nam

I would like to introduce the technique of laparoscopic pancreaticoduodenectomy. The procedure is performed with the patient in the supine position. Typically, a total of 6 trocars are used for the procedure.

The procedure begins with mobilization of the hepatic flexure and a wide Kocher’s maneuver to rule out pathological lymphadenopathy. The right gastroepiploic vessels are ligated and divided and the gastro-colic ligament is dissected in order to enter the lesser sac and to expose the antral region. Following the middle colic vein, the superior mesenteric vein is reached below the inferior border of the pancreas and the retro-pancreatic tunnellization begins. The portal vein is identified at the superior border of the pancreatic neck. The retropancreatic tunnellization is completed and a loop is passed around the pancreas.

The cholecystectomy is then performed, now the lymphadenectomy of the hepatoduodenal ligament begins along the course of the proper hepatic artery. During the dissection, the origin of the right gastric artery is identified. The lymphadenectomy continues by removing all the lymphatic tissue surrounding the common bile duct up to the hepatic hilum.

The first portion of the duodenum is transected with a linear stapler 2 to 3 cm distal to the pylorus. The gastroduodenal and right gastric arteries are ligated, and divided.
The first jejunal loop is divided using a linear stapler, the jejunal stump is passed into the supramesocolic compartment .

Dissection of the pancreatic head and uncinate process off the portal vein, superior mesenteric vein, and superior mesenteric artery is typically performed using hem-o-lock clip and ultrasonic shears. Larger tributary vessels (pancreaticoduodenal vessels) are clipped.The pancreatic neck parenchyma is divided ultrasonic shears. The Wirsung’s duct is identified. All peripancreatic lymphatic tissue is taken en bloc with the specimen. The common bile duct is divided. The dissection step is completed

An end-to-side, pancreaticojejunostomy, duct-to-mucosa anastomosis is performed over an 8-cm Silastic tube with an inner layer of 5-0 PDS sutures and an outer layer of running 4 -0 PDS sutures. An end-to-side hepaticojejunostomy is performed with running 4-0 PDS sutures.An antecolic, end-to- side duodenojejunostomy is performed with 2 layers of running 3-0 Vicryl

The specimen is then removed in an endosac via the infraumbilical trocar site extended. This is a view of the abdominal incision as seen at the end of the procedure.

Session: Podium Presentation

Program Number: V004

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