Total Laparoscopic Pancreatoduodenectomy

  • Maurice J. W. Zwart
  • Thijs de Rooij
  • Olivier R. C. Busch
  • Michael F. Gerhards
  • Sebastiaan Festen
  • Marc G. H. BesselinkEmail author


Pancreatoduodenectomy is the treatment of choice for pancreatic head and periampullary cancers and high-risk pancreatic cysts. Laparoscopic pancreatoduodenectomy, firstly performed in 1994 [1], has gained popularity only slowly, probably because of the required extensive laparoscopic dissection and the difficulty of the pancreatic and bile duct anastomoses. Improvements in surgical expertise, instrumentation and several cohort studies have apparently driven to the recent increased interest in laparoscopic pancreatoduodenectomy [2]. Nevertheless, only a few centers have acquired adequate experience with this complex procedure. A recent pan-European survey demonstrated that although 73% of pancreatic surgeons performed minimally invasive distal pancreatectomy, only 4.4% of surgeons had performed more than ten minimally invasive pancreatoduodenectomies [3]. A laparoscopic approach to pancreatic and periampullary lesions may enhance postoperative functional recovery and potentially shorten time to start with adjuvant chemotherapy. Naturally, a learning curve arises with the adaptation of a laparoscopic approach. This is reflected in reports on the laparoscopic pancreatoduodenectomy learning curve which is completed faster with extensive previous experience in laparoscopic surgery and adequate training in pancreatic surgery [4]. Additionally, high-quality surgical performance and low conversion rates are best achievable in high-volume centers [5].


Laparoscopy Pancreas Pancreatoduodenectomy 

Supplementary material

Video 24.1

Total laparoscopic duodenopancreatectomy (MP4 307260 kb)


  1. 1.
    Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408–10.CrossRefPubMedGoogle Scholar
  2. 2.
    Boggi U, Ugo B, Gabriella A, Fabio V, Fabio C, De Lio N, Vittorio P, Linda B, Mario B, Stefano S, Franco M. Laparoscopic pancreaticoduodenectomy: a systematic literature review. Surg Endosc. 2014;29:9–23.CrossRefPubMedGoogle Scholar
  3. 3.
    De Rooij T, Besselink M, Shamali A, Butturini G, Busch O, Troisi R, Fernández-Cruz L, Topal B, Dagher I, Bassi C, Abu Hilal M. Pan-European survey on laparoscopic pancreatic surgery. HPB. 2016;18:e852–3.CrossRefGoogle Scholar
  4. 4.
    de Rooij T, van Hilst J, Boerma D, Bonsing BA, Daams F, van Dam RM, Dijkgraaf MG, van Eijck CH, Festen S, Gerhards MF, Koerkamp BG, van der Harst E, de Hingh IH, Kazemier G, Klaase J, de Kleine RH, van Laarhoven CJ, Lips DJ, Luyer MD, Molenaar IQ, Patijn GA, Roos D, Scheepers JJ, van der Schelling GP, Steenvoorde P, Vriens MR, Wijsman JH, Gouma DJ, Busch OR, Abu Hilal M, Besselink MG. Dutch pancreatic cancer group: impact of a nationwide training program in minimally invasive distal pancreatectomy (LAELAPS). Ann Surg. 2016;264(5):754–62.CrossRefPubMedGoogle Scholar
  5. 5.
    Sharpe SM, Talamonti MS, Wang CE, Prinz RA, Roggin KK, Bentrem DJ, Winchester DJ, Marsh RDW, Stocker SJ, Baker MS. Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy from the National Cancer Data Base. J Am Coll Surg. 2015;221:175–84.CrossRefPubMedGoogle Scholar
  6. 6.
    de Rooij T, Klompmaker S, Abu Hilal M, Kendrick ML, Busch OR, Besselink MG. Laparoscopic pancreatic surgery for benign and malignant disease. Nat Rev Gastroenterol Hepatol. 2016;13:227–38.CrossRefPubMedGoogle Scholar
  7. 7.
    Wang M, Meng L, Cai Y, Li Y, Wang X, Zhang Z, Peng B. Learning curve for laparoscopic pancreaticoduodenectomy: a CUSUM analysis. J Gastrointest Surg. 2016;20:924–35.CrossRefPubMedGoogle Scholar
  8. 8.
    Boone BA, Zenati M, Hogg ME, Steve J, Moser AJ, Bartlett DL, Zeh HJ, Zureikat AH. Assessment of quality outcomes for robotic pancreaticoduodenectomy: identification of the learning curve. JAMA Surg. 2015;150:416–22.CrossRefPubMedGoogle Scholar
  9. 9.
    Tol JAMG, van Hooft JE, Timmer R, Kubben FJGM, van der Harst E, de Hingh IHJT, Vleggaar FP, Molenaar IQ, Keulemans YCA, Boerma D, Bruno MJ, Schoon, EJ, van der Gaag NA, Besselink MGH, Fockens P, van Gulik TM, Rauws EAJ, Busch ORC, Gouma DJ. Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut. 2015; 65(12). gutjnl-2014-308762.Google Scholar
  10. 10.
    van der Gaag NA, de Castro SMM, Rauws EAJ, Bruno MJ, van Eijck CHJ, Kuipers EJ, Gerritsen JJ, Jan-Paul R, Greve JW, Hesselink EJ, Klinkenbijl JHG, Rinkes IHMB, Djamila B, Bonsing BA, van Laarhoven CJ, Kubben FJ, van der Harst E, Sosef MN, Koop B, de Hingh IH, de Wit LT, van Delden OM, Busch ORC, van Gulik TM, Bossuyt PMM, Gouma DJ. Preoperative biliary drainage for periampullary tumors causing obstructive jaundice; DR ainage vs. (direct) OP eration (DROP-trial). BMC Surg. 2007;7Google Scholar
  11. 11.
    Chew HK. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166:458–64.CrossRefPubMedGoogle Scholar
  12. 12.
    Keidar A, Andrei K. P102: high incidence of bleeding complications with preoperative administration of enoxaparine for venous thromboembolism prevention in bariatric patients. Surg Obes Relat Dis. 2008;4:350.CrossRefGoogle Scholar
  13. 13.
    Mungroop TH, Veelo DP, Busch OR, van Dieren S, van Gulik TM, Karsten TM, de Castro SM, Godfried MB, Thiel B, Hollmann MW, Lirk P, Besselink MG. Continuous wound infiltration or epidural analgesia for pain prevention after hepato-pancreato-biliary surgery within an enhanced recovery program (POP-UP trial): study protocol for a randomized controlled trial. Trials. 2015;16:562.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lee JS, Kim JJ, Park SM. A simple method of liver retraction for various types of laparoscopic upper gastrointestinal surgeries: the prolene hanging-up method. World J Surg. 2015;39:2362–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Topal B, Baki T, Steffen F, Raymond A, Joseph W, Tom F, Geert R, Claude B, Catherine H, Marc J, Jean C. Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy for pancreatic or periampullary tumours: a multicentre randomised trial. Lancet Oncol. 2013;14:655–62.CrossRefPubMedGoogle Scholar
  16. 16.
    Zonderhuis BM, van den Boom AL, de Graaf E, Meijer LL, Kazemier G, Scheepers JJ. Tattoo of scheepers. HPB. 2016;18:e597.CrossRefGoogle Scholar
  17. 17.
    Dort JC, Farwell DG, Findlay M, Huber GF, Kerr P, Shea-Budgell MA, Simon C, Uppington J, Zygun D, Ljungqvist O, Harris J. Optimal perioperative care in major head and neck cancer surgery with free flap reconstruction: a consensus review and recommendations from the enhanced recovery after surgery society. JAMA Otolaryngol Head Neck Surg. 2016.Google Scholar
  18. 18.
    Pancreatic head and peri-ampullary cancer laparoscopic vs. open surgical treatment trial (PLOT).
  19. 19.
    Poves Prim I. PADULAP study: to compare postoperative and pathologic results between open and laparoscopic approach for pancreaticoduodenectomy.
  20. 20.
  21. 21.
    Rodríguez-Sanjuán JC. Laparoscopic and robot-assisted laparoscopic digestive surgery: present and future directions. World J Gastroenterol. 2016;22:1975.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Napoli N, Niccolò N, Kauffmann EF, Francesca M, Perrone VG, Stefania B, Ugo B. Indications, technique, and results of robotic pancreatoduodenectomy. Updat Surg. 2016;68(3):295–305.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Maurice J. W. Zwart
    • 1
  • Thijs de Rooij
    • 1
  • Olivier R. C. Busch
    • 1
  • Michael F. Gerhards
    • 2
  • Sebastiaan Festen
    • 2
  • Marc G. H. Besselink
    • 1
    Email author
  1. 1.Department of SurgeryAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Department of SurgeryOLVG HospitalAmsterdamThe Netherlands

Personalised recommendations