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Updated: Mar 26, 2026
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Comparison Between Minimally Invasive and Open Pancreaticoduodenectomy: A Systematic Review
Chrysoula Doula1, Ioannis D Kostakis, Christos Damaskos
1*Second Department of Propedeutic Surgery †First Department of Surgery, "Laiko" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Introduction:
Minimally invasive approaches (laparoscopic or robotic) are used in various operations. Our aim was to compare them with the open approach in pancreaticoduodenectomy.
Methods:
We conducted a search for articles published in MEDLINE database comparing minimally invasive (laparoscopic or robotic) with open pancreaticoduodenectomy on June 15, 2014.
Results:
Our search yielded 136 articles. We excluded 122 articles and we took into consideration 14 (10 for laparoscopic and 4 for robotic pancreaticoduodenectomies). Most cases were related to malignant diseases and tumors treated with minimally invasive operations tended to be smaller. There were relatively high conversion rates in both laparoscopic (0% to 15%) and robotic procedures (4.5% to 10%). There were no significant differences regarding resection margins, rates of pancreatic fistula formation, bile leak, and delayed gastric emptying, reoperation rates, and intraoperative and postoperative mortality. On the contrary, blood loss was less in minimally invasive than open operations, although this difference was not always significant. Moreover, totally laparoscopic and robotic procedures lasted longer than the open ones, whereas hand-assisted laparoscopic procedures did not. However, the findings regarding the number of the retrieved lymph nodes, the length of hospital stay, and costs were inconclusive and controversial.
Conclusions:
Laparoscopic and robotic pancreaticoduodenectomy are feasible, safe, and oncologically equivalent alternatives to open pancreaticoduodenectomy. Minimally invasive operations have the advantage of the less blood loss, but totally laparoscopic and robotic procedures last longer than open procedures.
Insights
Minimally invasive pancreaticoduodenectomy (laparoscopic or robotic) is a safe and effective alternative to open surgery. While offering reduced blood loss, these procedures may involve longer operating times compared to traditional methods.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Minimally invasive surgical techniques, including laparoscopic and robotic approaches, are increasingly utilized in complex abdominal operations.
- Pancreaticoduodenectomy, a major surgical procedure, traditionally involves an open approach.
Purpose of the Study:
- To compare the outcomes of minimally invasive (laparoscopic and robotic) pancreaticoduodenectomy with the traditional open approach.
- To evaluate safety, efficacy, and oncological outcomes of different surgical modalities.
Main Methods:
- A systematic literature search was performed on the MEDLINE database up to June 15, 2014.
- Included studies directly compared minimally invasive (laparoscopic or robotic) pancreaticoduodenectomy with open pancreaticoduodenectomy.
Main Results:
- Analysis of 14 studies revealed that tumors treated with minimally invasive surgery were generally smaller.
- No significant differences were observed in oncological outcomes (resection margins, lymph node retrieval) or major complications (fistula, leak, mortality).
- Minimally invasive approaches demonstrated reduced blood loss but potentially longer operative times for totally laparoscopic/robotic procedures, with high conversion rates noted.
Conclusions:
- Laparoscopic and robotic pancreaticoduodenectomy are feasible, safe, and oncologically sound alternatives to open surgery.
- Minimally invasive techniques offer the benefit of decreased blood loss.
- Totally laparoscopic and robotic pancreaticoduodenectomy procedures tend to have longer durations than open procedures.
