Total Laparoscopic Whipples Pancreaticoduodenectomy -early Experience with 3 Cases

Objective:Laparoscopic Whipples Pancreaticoduodenectomy considered to be technically difficult operation. A video of the Laparoscopic procedure of one of the cases done at our center is presented here
Method&Results:Three patients with Periampullay carcinoma underwent Total Laparoscopic Whipples Pancreaticoduodenectomy during the period Nov2008-Aug2009 .5ports were used. Mobilisation and reconstruction was done as in open Whipples procedure. The stomach was transected at the Pylorus. Jejunum was transected close to DJ flexure. Neck of Pancreas and the uncinate process was divided using ultrasonic shears. Finally Common Bile Duct was transected.
The reconstruction was done as Pancreaticogastrostomy (Duct to mucosa) in 2 cases Pancreatico jejunostomy in one case, Choledochojejunostomy and side to side Gastrojejunostomy in all cases.The specimen was extracted through a 5cm size ifraumbilical incision.
The average surgery time was 490mins.The average blood loss was 233ml. Delayed gastric emptying was a problem in all patients. The average post operative stay was 18.3days.One patient required Percutaneous drainage for perigastric collection.
Conclusion: The entire surgery was done by Laparoscopic approach. It is feasible to perform Whipples Pancreaticoduodenectomy by laparoscopic method with good resuls.The morbidity and the hospital stay are found to be high. However it can be improved to satisfactory level with bigger experience

Session: Video Channel

Program Number: V067

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