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Updated: Feb 20, 2026
Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Reproducible Laparoscopic Hepaticojejunostomy Using a Double-Armed Suture Technique Performed by a Procedure-Naïve
Mampei Kawashima1, Yoshiharu Nakamura1, Akira Matsushita2
1Department of Gastrointestinal Surgery, Nippon Medical School Chiba Hokuso Hospital, Chiba, Japan.
Background:
While minimally invasive pancreaticoduodenectomy (MIPD) has become increasingly common, biliary reconstruction remains a formidable technical hurdle. Ensuring the reproducibility of hepaticojejunostomy, particularly when performed by procedure-naïve surgeons, is a critical challenge.
Methods:
We retrospectively analyzed consecutive patients who underwent MIPD with laparoscopic hepaticojejunostomy using a standardized technique employing a handmade double-armed suture. All procedures were performed by a procedure-naïve U40 surgeon under expert supervision. The anastomotic safety and reconstruction time were evaluated to assess reproducibility.
Results:
A total of 23 patients were included. No bile leakage was observed, and anastomotic stricture occurred in 1 patient. The reconstruction time showed minimal variability throughout the series, indicating stable procedural performance from the early phase.
Conclusion:
A standardized laparoscopic hepaticojejunostomy technique can be safely and reproducibly performed by a procedure-naïve surgeon with sufficient foundational experience under structured supervision. Technique-based standardization may complement existing training strategies and facilitate sustainable dissemination of MIPD.
