Related Experiment Video
Updated: Jul 20, 2026
Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy
Published on: June 17, 2018
Laparoscopic pancreatoduodenectomy with 3D vision compared to 2D vision is associated with less severe morbidity and
Safi Dokmak1, Charles de Ponthaud2, Chihebeddine Romdhani3
1Department of Hepato-bilio-pancreatic Surgery and Liver Transplantation, APHP, Hôpital Beaujon, DMU DIGEST, Clichy, France; Université de Paris Cité, France; Centre de Recherche sur L'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy, France.
Background:
Laparoscopic surgery with three-dimensional (3D) vision has recently been introduced, allowing enhanced visualization and improved suturing capabilities. However, its clinical impact has not been widely studied, particularly in laparoscopic pancreatoduodenectomy (LPD), where visualization and suturing are critical. In this study, we compared outcomes between 2D and 3D LPD.
Methods:
In our center, the first 2D-LPD was performed in 2011, and 3D-LPD was introduced in 2019. To assess the impact of 3D vision while minimizing bias related to the learning curve, we compared two consecutive four-year periods before and after the implementation of 3D vision: a first period with 2D-LPD (2015-2018) and a second period with 3D-LPD (2019-2022). There were no major modifications in surgical technique between the two periods. Operative and postoperative outcomes were compared between 2D and 3D LPD, both before and after propensity score matching. A generalized linear mixed model (GLMM) was associated to account for the time-effect.
Results:
During the study period, 162 LPDs were performed, including 79 with 2D-LPD and 83 with 3D-LPD. There was no significant difference in baseline clinical characteristics, except for ampullary tumors, which were more frequently operated on in the 2D-LPD group (16 % vs. 4.8 %; p = 0.016). Operative data and pancreatic characteristics were similar between groups. However, 3D-LPD was associated with a lower conversion rate (0 % vs. 6 %; p = 0.026) and a lower transfusion rate (0 % vs. 6 %; p = 0.027). After propensity score matching (2D-LPD: n = 39; 3D-LPD: n = 83), outcomes remained significantly better with 3D-LPD, with fewer grade C postoperative pancreatic fistulas (10 % vs. 2 %; p = 0.038) and lower readmission rates (10 % vs. 0 %; p = 0.009), while median hospital stay was similar between groups (14 vs. 15 days; p = 0.699).
Conclusion:
This study shows that 3D-LPD, compared to 2D-LPD, is associated with a lower incidence of grade C postoperative pancreatic fistula and readmission. Given its availability and cost-effectiveness compared to robotic surgery, 3D-LPD should be promoted.
