Skip to main content
Log in

Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center

  • Topics
  • Evolution and challenge in endoscopic HBP surgery
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Background

Laparoscopic pancreaticoduodenectomy is a technically demanding surgery performed only at few centers in the world. This article aims to describe the evolution of the technique and summarizes the results in our institute over the years.

Methods

Prospective data of patients undergoing laparoscopic pancreaticoduodenectomy from March 1998 to January 2009 was retrospectively reviewed.

Results

There were a total of 75 patients (22 females and 53 males) with a mean age of 62 (range, 28–76) years. Conversion rate was 0%, overall postoperative morbidity was 26.7% and mortality rate was 1. 33%. Pancreatic fistula was seen in 6.67%. The mean operating time was 357 min (range 270–650), and the mean blood loss was 74 ml (range 35–410). The average time to the first bowel movement was 3 days and mean hospital stay was 8.2 days (range 6–42). Resected margins were positive in 2.6% of cases. The mean number of retrieved lymph nodes for the malignant lesions was 14 (range 8–22).

Conclusion

Laparoscopic pancreaticoduodenectomy can be safely performed by highly skilled laparoscopic surgeons. This technique can achieve adequate margins and follow oncological principles. Randomized comparative trials are needed to establish the superiority of laparoscopy versus open surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others

References

  1. Salky BA, Edye M. Laparoscopic pancreatectomy. Surg Clin North Am. 1996;76:539–45.

    Article  CAS  PubMed  Google Scholar 

  2. Cuschieri A, Jakimowicz JJ. Laparoscopic pancreatic resection. Semin Laparosc Surg. 1998;5:168–79.

    CAS  PubMed  Google Scholar 

  3. Salky BA, Edye M. Laparoscopic pancreatectomy. Surg Clin North Am. 1996;76:539–45.

    Article  CAS  PubMed  Google Scholar 

  4. Patterson EJ, Gagner M, Salky B, Inabnet WB, Brower S, Edye M, et al. Laparoscopic pancreatic resection: single-institution experience of 19 patients. J Am Coll Surg. 2001;193:281–7.

    Article  CAS  PubMed  Google Scholar 

  5. Tagaya N, Kasama K, Suzuki N, Taketsuka S, Horie K, Kubota K, et al. Laparoscopic resection of the pancreas and review of the literature. Surg Endosc. 2003;17:201–6.

    Article  CAS  PubMed  Google Scholar 

  6. Pugliese R, Scandroglio I, Sansonna F, Maggioni D, Costanzi A, Citterio D, et al. Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech. 2008;18(1):13–8.

    Article  PubMed  Google Scholar 

  7. Menon KV, Hayden JD, Prasad KR, Verbeke CS. Total laparoscopic pancreaticoduodenectomy and reconstruction for a cholangiocarcinoma of the bile duct. J Laparoendosc Adv Surg Tech. 2007;17(6):775–80.

    Article  Google Scholar 

  8. Zhao Y, Shen S, Guo J. Pancreatic cancer—laparoscopic resection. Chinese–German. J Clin Oncol. 2007;6(2):154–8.

    Google Scholar 

  9. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8(5):408–10.

    Article  CAS  PubMed  Google Scholar 

  10. Kimura Y, Hirata K, Mukaiya M, et al. Hand-assisted laparoscopic pylorus-preserving pancreaticoduodenectomy for pancreas head disease. Am J Surg. 2005;189:734–7.

    Article  PubMed  Google Scholar 

  11. Ammori BJ. Laparoscopic hand-assisted pancreaticoduodenectomy: initial UK experience. Surg Endosc. 2004;18:717–8.

    Article  Google Scholar 

  12. Gagner M. Laparoscopic duodenopancreatectomy. In: Steichen F, Welter R, editors. Minimally invasive surgery and technology. St. Louis: Quality Medical Publishing; 1994. p. 192–9.

    Google Scholar 

  13. Cuschieri A. Laparoscopic pancreatic resections. Semin Laparosc Surg. 1996;3:15–20.

    PubMed  Google Scholar 

  14. Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV. Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg. 2007;205(2):222–30.

    Article  PubMed  Google Scholar 

  15. Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A. Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc. 2005;19:1028–34.

    Article  CAS  PubMed  Google Scholar 

  16. Huscher CGS, Di Paola M, Ponzano C. Laparoscopic pancreaticoduodenectomy. J Gastrointest Surg. 2005;9(4):608.

    Article  Google Scholar 

  17. Sutton CD, Garcea G, White SA, O’Leary E, Marshall LJ, Berry DP, et al. Isolated Roux-loop pancreaticojejunostomy: a series of 61 patients with zero postoperative pancreaticoenteric leaks. J Gastrointest Surg. 2004;8(6):701–5.

    Article  PubMed  Google Scholar 

  18. Khan AW, Agarwal AK, Davidson BR. Isolated Roux loop duct-to-mucosa pancreaticojejunostomy avoids pancreatic leaks in pancreaticoduodenectomy. Dig Surg. 2002;19(3):199–204.

    Article  PubMed  Google Scholar 

  19. Kaman L, Sanyal S, Behera A, Singh R, Katariya RN. Isolated Roux loop pancreaticojejunostomy vs single loop pancreaticojejunostomy after pancreaticoduodenectomy. Int J Surg. 2008;6(4):306–10.

    Article  PubMed  Google Scholar 

  20. Albertson DA. Pancreaticoduodenectomy with reconstruction by Roux-en-Y pancreaticojejunostomy: no operative mortality in a series of 25 cases. South Med J. 1994;87(2):197–201.

    Article  CAS  PubMed  Google Scholar 

  21. Palanivelu C, Rangarajan M, Jategaonkar PA, Anand NV. An innovative technique of colorectal specimen retrieval—a new era of “Natural Orifice Specimen Extraction” (NOSE). Dis Colon Rectum. 2008;51(7):1120–4.

    Article  PubMed  Google Scholar 

  22. “LaparoSurg 2007”: 7th International Live Workshop and Conference on Advanced Laparoscopic Surgery held at Coimbatore, India.

  23. The Second International Live Laparoscopic Surgery Meeting held at Dundee, UK in May 2008.

  24. Uyama I, Ogiwara H, Iida S, et al. Laparoscopic minilaparotomy pancreaticoduodenectomy with lymphadenectomy using an abdominal wall-lift method. Surg Laparosc Endosc. 1996;6:405–10.

    Article  CAS  PubMed  Google Scholar 

  25. Gumbs AA, Gayet B. The laparoscopic duodenopancreatectomy: the posterior approach. Surg Endosc. 2008;22(2):539–40.

    Article  PubMed  Google Scholar 

  26. Takaori K, Tanigawa N. Laparoscopic pancreatic resection: the past, present, and future. Surg Today. 2007;37:535–45.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C. Palanivelu.

About this article

Cite this article

Palanivelu, C., Rajan, P.S., Rangarajan, M. et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg 16, 731–740 (2009). https://doi.org/10.1007/s00534-009-0157-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00534-009-0157-8

Keywords

Navigation