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Updated: Aug 18, 2026
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Getting Started with Minimally Invasive Pancreaticoduodenectomy: Is It Worth It?
Shuyin Liang1, Shiva Jayaraman1,2
11 Division of General Surgery, University of Toronto , Toronto, Ontario, Canada .
Background:
This study evaluates the safety and cost of introducing minimally invasive pancreaticoduodenectomy (MIPD) to a surgeon's practice.
Subjects And Methods:
All MIPDs performed between December 2011 and July 2013 were compared with open pancreaticoduodenectomy (OPD) cases by the same surgeon. The primary outcomes were mortality, major morbidity, and re-operation. Secondary outcomes were perioperative and oncologic outcomes and cost. MIPD include total laparoscopic pancreaticoduodenectomy (TLPD) and laparoscopic-assisted pancreaticoduodenectomy (LAPD), where a small incision is used for reconstruction. Bivariate comparisons of outcomes were performed using nonparametric tests.
Results:
In total, 44 pancreaticoduodenectomies were performed: 15 MIPDs (2 TLPDs and 13 LAPDs) and 29 OPDs. One death occurred in each group. Major complication rates were not significantly different (33% for MIPD versus 17% for OPD); however, there was a trend toward more re-operation after MIPD compared with OPD (20% versus 3%; P = .07). The incidence of pancreatic leak (20% for MIPD versus 14% for OPD), biliary leak (0% versus 7%, respectively), abscess formation (27% versus 14%, respectively), and intraabdominal hemorrhage (13% versus 3%, respectively) were not significantly different. MIPD achieved equivalent oncologic outcomes as OPD with 100% R0 margin and adequate lymph node retrieval. There was no statistical difference in median operative time (342 minutes for MIPD versus 358 minutes for OPD), length of stay (8 versus 9 days, respectively), operating room expenses (Canadian) ($7246.0 versus $6912.0, respectively), or total cost (Canadian) per case ($15,034.0 versus $18,926.0, respectively).
Conclusions:
MIPD and OPD had similar safety and cost in this introductory series. However, a trend toward a higher rate of re-operation for pancreatic leak suggests the need for caution in introducing this novel technique.
Insights
Minimally invasive pancreaticoduodenectomy (MIPD) shows similar safety and cost to open pancreaticoduodenectomy (OPD) in an initial series. Caution is advised due to a trend of increased re-operations for pancreatic leaks with MIPD.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Evaluating the safety and cost-effectiveness of introducing minimally invasive pancreaticoduodenectomy (MIPD) into surgical practice.
- Comparing MIPD with traditional open pancreaticoduodenectomy (OPD) for safety and economic outcomes.
Purpose of the Study:
- To assess the feasibility and outcomes of MIPD compared to OPD.
- To determine if MIPD offers comparable safety, perioperative, and oncologic results to OPD.
Main Methods:
- Retrospective comparison of 15 MIPDs (total laparoscopic and laparoscopic-assisted) with 29 OPDs performed by the same surgeon.
- Primary outcomes included mortality, major morbidity, and re-operation rates.
- Secondary outcomes analyzed perioperative, oncologic results, and costs.
Main Results:
- MIPD and OPD demonstrated similar mortality and major complication rates.
- A trend towards higher re-operation rates was observed after MIPD (20% vs. 3%).
- Equivalent oncologic outcomes (R0 margin, lymph node retrieval) and comparable costs were achieved with MIPD.
Conclusions:
- MIPD is a safe and cost-effective alternative to OPD in an introductory surgical series.
- The observed trend in re-operations for pancreatic leaks necessitates careful consideration during MIPD implementation.
