• Arch Surg · Jan 2010

    Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience.

    • Michael L Kendrick and Daniel Cusati.
    • Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. kendrick.michael@mayo.edu
    • Arch Surg. 2010 Jan 1;145(1):19-23.

    HypothesisTotal laparoscopic pancreaticoduodenectomy is a safe and effective therapeutic approach.DesignSingle-institutional retrospective review.SettingTertiary referral center.PatientsAll consecutive patients undergoing total laparoscopic pancreaticoduodenectomy from July 2007 through July 2009 at a single center (n = 62).Main Outcome MeasuresBlood loss, operative time, postoperative morbidity, length of hospital stay, and 30-day or in-hospital mortality.ResultsOf 65 patients undergoing laparoscopic resection, 62 patients with a mean age of 66 years (SD, 12 years) underwent total laparoscopic pancreaticoduodenectomy. The pancreaticojejunostomy consisted of a duct-to-mucosa anastomosis with interrupted suture. Median operative time was 368 minutes (range, 258-608 minutes) and median blood loss was 240 mL (range, 30-1200 mL). Diagnosis was pancreatic adenocarcinoma (n = 31), intraductal papillary mucinous neoplasm (n = 12), periampullary adenocarcinoma (n = 8), neuroendocrine tumor (n = 4), chronic pancreatitis (n = 3), cholangiocarcinoma (n = 1), metastatic renal cell carcinoma (n = 1), cystadenoma (n = 1), and duodenal adenoma (n = 1). Median tumor size was 3 cm (range, 0.9-10.0 cm) and the median number of lymph nodes harvested was 15 (range, 6-31). Perioperative morbidity occurred in 26 patients and included pancreatic fistula (n = 11), delayed gastric emptying (n = 9), bleeding (n = 5), and deep vein thrombosis (n = 2). There was 1 postoperative mortality. Median length of hospital stay was 7 days (range, 4-69 days).ConclusionsLaparoscopic pancreaticoduodenectomy is feasible, safe, and effective. Outcomes appear comparable with those via the open approach; however, controlled trials are needed. Despite this series representing experience within the learning curve, laparoscopic pancreaticoduodenectomy holds promise for providing advantages seen with minimally invasive approaches in other procedures.

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