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Annals of Surgical Oncology

, Volume 22, Issue 13, pp 4380–4381 | Cite as

Total Laparoscopic Pancreaticoduodenectomy: A Single-Institutional Experience

  • Alessandro Paniccia
  • Richard D. Schulick
  • Barish H. Edil
Gastrointestinal Oncology

Abstract

Introduction

Laparoscopic pancreaticoduodenectomy represents one of the most advanced abdominal surgical procedures; however, a standard approach is still lacking. We present our initial experience with total laparoscopic pancreaticoduodenectomy (TLPD) with a video of the technique that we have developed and the clinical as well as oncologic outcomes obtained with this technique.

Methods

This was a retrospective review of all cases consecutively performed by two operators between January 2013 and December 2014 at The University of Colorado (Fig. 1).
Fig. 1

Pathology of resected lesions via total laparoscopic pancreaticoduodenectomy (N = 30)

Results

Thirty patients underwent TLPD; conversion to open procedure was required in two cases (6 %). Median age at diagnosis was 63.1 years [interquartile range (IQR) 53.8–70.8]. Operative characteristics and postoperative complications are summarized in Table 1. The operative time decreased from 366 minutes (IQR 320–421) in the first 15 cases to 312 min (IQR 282–372) in the second 15 cases (r = −2.7; p = 0.047). The estimated blood loss decreased from 300 mL (IQR 300–500) in the first 15 cases to 200 mL (IQR 150–375) in the second 15 cases (r = −6.3; p = 0.314).
Table 1

Operative characteristics and postoperative complications

Variable

N = 30

Surgical margin

 Negative R0

30 (100 %)

Number of nodes harvested

 Median (range)

18 (15–22)

Operative time (min)

 Median (range)

340 (308–377)

EBL (mL)

 Median (range)

300 (200–400)

Pancreatic fistula

15 (50 %)

Pancreatic fistula grade

 A

8 (27 %)

 B

5 (17 %)

 C

2 (7 %)

Delayed gastric emptying (DGE)

10 (33 %)

DGE grade

 A

4 (14 %)

 B

5 (17 %)

 C

1 (3 %)

Bile leak

3 (10 %)

Pseudoaneurysm

 Hepatic artery

2 (7 %)

 GDA

1 (3 %)

Chyle leak

1 (3 %)

Surgical site infection (SSI)

6 (20 %)

SSI type

 Superficial

2 (7 %)

 Deep

0

 Organ space

6 (20 %)

LOS (days)

 Median (range)

11 (8–15)

Readmission (30 days)

6 (20 %)

Death (90 days)

0

Conclusions

Laparoscopic pancreaticoduodenectomy is a challenging operation, which is not performed in high volume at most centers. As a new laparoscopic pancreas program, our experience shows that oncologic outcomes are acceptable in terms of margin and lymph node harvest. There is undoubtedly a steep learning curve that complicates the initial application of TLPD; however, with the techniques displayed in this video many of the early complications can be overcome. Further study to evaluate for long-term safety is needed.

Keywords

Oncol Oncologic Outcome Estimate Blood Loss Early Complication Delay Gastric Emptying 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Supplementary material 1 (MP4 718291 kb)

10434_2015_4450_MOESM2_ESM.zip (239 mb)
Supplementary material 2 (ZIP 244694 kb)
10434_2015_4450_MOESM3_ESM.zip (3884.1 mb)
Supplementary material 3 (ZIP 3977329 kb)

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Alessandro Paniccia
    • 1
  • Richard D. Schulick
    • 1
  • Barish H. Edil
    • 2
  1. 1.Department of SurgeryUniversity of Colorado Anschutz Medical CampusAuroraUSA
  2. 2.Pancreas and Biliary SurgeryUniversity of Colorado Anschutz Cancer PavilionAuroraUSA

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