Total Laparoscopic Pancreaticoduodenectomy: A Single-Institutional Experience

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastrointestinal Surgery

Background:

• Laparoscopic pancreaticoduodenectomy (LPD) is an advanced surgical procedure with evolving techniques.
• A standardized approach for LPD is still under development.
• This study presents initial clinical and oncologic outcomes of a developed Total Laparoscopic Pancreaticoduodenectomy (TLPD) technique.

Purpose of the Study:

• To present a developed technique for Total Laparoscopic Pancreaticoduodenectomy (TLPD).
• To evaluate the initial clinical and oncologic outcomes of TLPD.
• To demonstrate how specific techniques can mitigate early complications associated with TLPD.

Main Methods:

• Retrospective review of 30 consecutive TLPD cases performed by two surgeons between January 2013 and December 2014.
• Analysis of operative characteristics, including operative time, blood loss, and conversion rates.
• Evaluation of postoperative complications such as pancreatic fistula, delayed gastric emptying, and surgical site infections.

Main Results:

• Thirty patients underwent TLPD with a 6% conversion rate to open surgery.
• Operative time and estimated blood loss decreased significantly between the first and second 15 cases.
• Key complications included pancreatic fistula (50%), delayed gastric emptying (33%), and surgical site infection (20%).
• All 30 patients achieved negative R0 surgical margins, with a median of 18 lymph nodes harvested.

Conclusions:

• TLPD is a feasible but challenging procedure, particularly for new programs.
• The developed TLPD technique yields acceptable oncologic outcomes regarding margin status and lymph node yield.
• Mastering TLPD involves a learning curve, but specific techniques can help overcome initial challenges and improve safety.