Laparoscopic Whipple procedure: review of the literature

  • Michel Gagner
  • Mariano Palermo
Topics Evolution and challenge in endoscopic HBP surgery



Laparoscopic pancreatic surgery represents one of the most advanced applications for laparoscopic surgery currently in use. In the past, minimally invasive techniques were only used for diagnostic laparoscopy, staging of pancreatic cancer, and palliative procedures for unresectable pancreatic cancer. With new advances in technology and instrumentation, some sophisticated procedures are currently available, such as the Whipple procedure, one of the most sophisticated applications of minimally invasive surgery.

Materials and methods

A review of the literature shows that 146 laparoscopic Whipple procedures have been published worldwide since 1994. The authors analyzed blood loss, mean operating time, hospital stay, conversion rate, mean age, mortality rate, lymph nodes in the pathologic findings, follow up, and complications.


Mean age was 59.1 years; mean operating time was 439 min. The average blood loss for the reviewed literature was 143 mL; median hospital stay was 18 days; conversion rate was 46%; number of lymph nodes in the pathologic findings was 19; and mortalities related to the procedure was low, 2 patients (1.3%) and the complication rate was 16% (23/46 patients). Complications included 2 hemorrhages, 4 bowel obstructions, 1 stress ulcer, 1 delay of gastric emptying, 4 pneumonias, and 11 leaks.


This review demonstrates that the laparoscopic Whipple procedure is not only feasible but also safe, with low mortality and acceptable rates of complications.


Common Bile Duct Delay Gastric Emptying Stress Ulcer Bile Duct Carcinoma Whipple Procedure 
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.


  1. 1.
    Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A. Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc. 2005;19(8):1028–34.CrossRefPubMedGoogle Scholar
  2. 2.
    Olivié D, Lepanto L, Billiard JS, Audet P, Lavallée JM. Predicting resectability of pancreatic head cáncer with multi-detector CT. Surgical and pathologic correlation. JOP. 2007;8(6):753–8.PubMedGoogle Scholar
  3. 3.
    Mori T, Abe N, Sugiyama M, Atomi Y. Laparoscopic pancreatic surgery. J Hepatobiliary Pancreat Surg. 2005;12(6):451–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Masson B, Sa-Cunha A, Laurent C, Rault A, Collet D. Laparoscopic pancreatectomy: report of 22 cases. Ann Chir. 2003;128(7):452–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Spanknebel K, Conlon KC. Advances in the surgical management of pancreatic cancer. Cancer J. 2001;7(4):312–23.PubMedGoogle Scholar
  6. 6.
    Strasberg SM, Drebin JA, Soper NJ. Evolution and current status of the Whipple procedure: an update for gastroenterologists. Gastroenterology. 1997;113(3):983–94.CrossRefPubMedGoogle Scholar
  7. 7.
    Schäfer M, Müllhaupt B, Clavien PA. Evidence based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Ann Surg. 2002;236(2):137–48.CrossRefPubMedGoogle Scholar
  8. 8.
    Gagner M, Pomp A. Laparoscopic pancreatic resection: is it a worthwhile? J Gastrointest Surg. 1997;1(1):20–5. (discussion 25-6).CrossRefPubMedGoogle Scholar
  9. 9.
    Gagner M, Pomp A. Laparoscopic pylorus preserving pancreatoduodenectomy. Surg Endosc. 1994;8(5):408–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Pugliese R, Scandroglio I, Sansonna F, Maggioni D, Costanzi A, Citterio D, et al. Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech. 2008;18(1):13–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc. 2006;20(7):1045–50.CrossRefPubMedGoogle Scholar
  12. 12.
    Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV. Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg. 2007;205(2):222–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Milone L, Turner P, Gagner M. Laparoscopic surgery for pancreatic tumors, an uptake. Minerva Chir. 2004;59(2):165–73.PubMedGoogle Scholar
  14. 14.
    Staudacher C, Orsenigo E, Baccari P, Di Palo S, Crippa S. Laparoscopic assisted duodenopancreatectomy. Surg Endosc. 2005;19(3):352–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Lu B, Cai X, Lu W, Huang Y, Jin X. Laparoscopic pancreaticoduodenectomy to treat cancer of the ampulla the Vater. JSLS. 2006;10(1):97–100.PubMedGoogle Scholar
  16. 16.
    Zheng MH, Feng B, Lu AG, Li JW, Hu WG, Wang ML, et al. Laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma of common bile duct: a case report and literature review. Med Sci Monit. 2006;12(6):CS57–60.PubMedGoogle Scholar
  17. 17.
    Sa Cunha A, Rault A, Beau C, Laurent C, Collet D, Masson B. A single institution prospective study of laparoscopic pancreatic resection. Arch Surg. 2008;143(3):289–95. (discussion 295).CrossRefPubMedGoogle Scholar
  18. 18.
    Gentileschi P, Gagner M. Laparoscopic pancreatic resection. Chir Ital. 2001;53(3):279–89.PubMedGoogle Scholar
  19. 19.
    Ammori BJ. Laparoscopic hand assisted pancreaticoduodenectomy: initial UK experience. Surg Endosc. 2004;18(4):717–8.CrossRefGoogle Scholar
  20. 20.
    Huang J, Yeo C, Sohn T, Lillemoe KD, Sauter PK, Coleman J, et al. Quality of life and outcomes after pancreaticoduodenectomy. Ann Surg. 2000;231(6):890–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Diener M, Knaebel P, Heukaufer C, Antes G, Buchler M, Seiler C. A systematic review and meta-analysis of pylorus preserving versus classical pancreaticoduodenectomy for surgical treatment of periampullary and pancreatic carcinoma. Ann Surg. 2007;245(2):187–200.CrossRefPubMedGoogle Scholar
  22. 22.
    Raut C, Tseng J, Sun C, Wang H, Wolff RA, Crane CH, et al. Impact of resection status on pattern failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg. 2007;246(1):52–60.CrossRefPubMedGoogle Scholar
  23. 23.
    Eubanks S, Swanstron L, Soper N. Mastery of endoscopic and laparoscopic surgery. Lippincott Williams & Wilkins 2000, Chapter 32. Laparoscopic Pancreatic Surgery. Michel Gagner 291–305.Google Scholar
  24. 24.
    Pappas T, Pryor A, Harnisch M. Atlas of laparoscopic surgery. 3rd ed. New York: Springer; 2008.Google Scholar
  25. 25.
    Assalia A, Gagner M. Laparoscopic pancreatic surgery for islet cell tumors of the pancreas. World J Surg. 2004; 28(12): 1239–47.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  1. 1.Department of SurgeryMount Sinai Medical CenterMiami BeachUSA
  2. 2.Department of SurgeryHospital Nacional Prof. A. Posadas. HaedoBuenos AiresArgentina

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