Skip to main content

Laparoscopic Pancreaticoduodenectomy

  • 1998 Accesses


Laparoscopic pancreaticoduodenectomy (LPD) is a formidable surgical procedure which requires experience and expertise in both open and laparoscopic pancreatic surgery. This chapter describes proper case selection, technical factors, potential complications, and the present status of LPD. Essentially, the technique involves three operative phases of resection and reconstruction. An experienced surgical team and ergonomic port placement aid in accomplishing this complicated surgical procedure. The use of energy devices, such as bipolar vessel sealers and ultrasonic shears, may decrease operative times and reduce blood loss. Standardization of techniques have resulted in favorable short term and oncologic outcomes when compared to the open approach.


  • Pancreatic cancer
  • Periampullary cancer
  • Laparoscopic

This is a preview of subscription content, access via your institution.

Buying options

USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-1-4939-1893-5_11
  • Chapter length: 11 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
USD   99.00
Price excludes VAT (USA)
  • ISBN: 978-1-4939-1893-5
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   129.00
Price excludes VAT (USA)
Fig. 11.1
Fig. 11.2
Fig. 11.3
Fig. 11.4
Fig. 11.5
Fig. 11.6
Fig. 11.7
Fig. 11.8
Fig. 11.9


  1. Bernheim IV BM. Organoscopy: cystoscopy of the abdominal cavity. Ann Surg. 1911;53(6):764–7.

    CAS  PubMed Central  PubMed  CrossRef  Google Scholar 

  2. Cuschieri A, Hall AW, Clark J. Value of laparoscopy in the diagnosis and management of pancreatic carcinoma. Gut. 1978;19(7):672–7.

    CAS  PubMed Central  PubMed  CrossRef  Google Scholar 

  3. Warshaw AL, Tepper JE, Shipley WU. Laparoscopy in the staging and planning of therapy for pancreatic cancer. Am J Surg. 1986;151(1):76–80.

    CAS  PubMed  CrossRef  Google Scholar 

  4. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8(5): 408–10.

    CAS  PubMed  CrossRef  Google Scholar 

  5. Palanivelu C, Rajan PS, Rangarajan M, Vaithiswaran V, Senthilnathan P, Parthasarathi R, et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg. 2009;16(6):731–40. doi:10.1007/s00534-009-0157-8.

    CAS  PubMed  CrossRef  Google Scholar 

  6. Castillo C. Endoscopic ultrasound in the papilla and the periampullary region. World J Gastrointest Endosc. 2010;2(8):278–87. doi:10.4253/wjge.v2.i8.278.

    PubMed Central  PubMed  CrossRef  Google Scholar 

  7. Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy. HPB (Oxford). 2011;13(7):454–8. doi:10.1111/ j.1477-2574.2011.00323.x.

    CrossRef  Google Scholar 

  8. Zureikat AH, Breaux JA, Steel JL, Hughes SJ. Can laparoscopic pancreaticoduodenectomy be safely implemented? J Gastrointest Surg. 2011;15(7):1151–7. doi:10.1007/s11605-011-1530-x.

    PubMed  CrossRef  Google Scholar 

  9. Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg. 2010;145(1):19–23. doi: 10.1001/archsurg.2009.243.

    PubMed  CrossRef  Google Scholar 

  10. 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. doi:10.1016/j.jamcollsurg.2007.04.004.

    PubMed  CrossRef  Google Scholar 

  11. Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc. 2006;20(7):1045–50. doi: 10.1007/s00464-005-0474-1.

    CAS  PubMed  CrossRef  Google Scholar 

  12. Kim SC, Song KB, Jung YS, Kim YH, Park do H, Lee SS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc. 2013;27(1):95–103.

    PubMed  CrossRef  Google Scholar 

  13. Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg. 2012;215(6):810–9. doi:10.1016/j.jamcollsurg.2012.08.006.

    PubMed  CrossRef  Google Scholar 

  14. Gumbs AA, Rodriguez Rivera AM, Milone L, Hoffman JP. Laparoscopic pancreatoduodenectomy: a review of 285 published cases. Ann Surg Oncol. 2011;18(5):1335–41. doi:10.1245/s10434-010-1503-4.

    PubMed  CrossRef  Google Scholar 

  15. Lei P, Wei B, Guo W, Wei H. Minimally invasive surgical approach compared with open pancreaticoduodenectomy: a systematic review and meta-analysis on the feasibility and safety. Surg Laparosc Endosc Percutan Tech. 2014;24(4):296–305. doi:10.1097/sle.0000000000000054.

    PubMed  CrossRef  Google Scholar 

  16. Langan RC, Graham JA, Chin AB, Rubinstein AJ, Oza K, Nusbaum JA, et al. Laparoscopic-assisted versus open pancreaticoduodenectomy: early favorable physical quality-of-life measures. Surgery. 2014;156(2):379–84. doi:10.1016/j.surg. 2014.03.018.

    PubMed  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Palanisamy Senthilnathan M.S., DNB GI Surgery, F.A.C.S. .

Editor information

Editors and Affiliations

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

In this video, the surgeon demonstrates his approach to laparoscopic pancreaticoduodenectomy. (WMV 266415 kb)

Key Operative Steps

Key Operative Steps

  1. 1.

    Place the patient in supine position on a split leg table.

  2. 2.

    Seven trocars/ports are generally needed to complete LPD.

  3. 3.

    Perform laparoscopic staging using LUS. May require division of the gastrocolic trunk and opening the plane posterior to the neck of the pancreas.

  4. 4.

    Perform Cattell-Braasch maneuver followed by wide kocherization of the duodenum.

  5. 5.

    Skeletonize the duodenum and divide the right gastric artery.

  6. 6.

    Divide the pylorus/duodenum with a laparoscopic GIA stapler.

  7. 7.

    Start the portal dissection with decompression of the gallbladder. Clip and divide the cystic artery and duct but do not remove the gallbladder. It will be used for retraction.

  8. 8.

    Transect the common hepatic duct above the level of the cystic duct. Place a bulldog clamp.

  9. 9.

    Clear all lymphatic tissues to fully visualize the proper hepatic artery and portal vein.

  10. 10.

    Identify and divide the gastroduodenal artery.

  11. 11.

    Take down the ligament of Treitz and divide the proximal jejunum.

  12. 12.

    Divide the pancreas at the neck.

  13. 13.

    Retract the small bowel mesentery to the left and expose the uncinate process. Retract the SMV to the left and resect the uncinate process close to the SMA.

  14. 14.

    Place the specimen into an endoscopic retrieval bag.

  15. 15.

    Bring the divided end of the jejunum up to the pancreas and perform a duct-to-mucosa anastomosis.

  16. 16.

    Perform single-layer hepaticojejunostomy.

  17. 17.

    Perform antecolic single-layer duodeno jejunostomy.

Rights and permissions

Reprints and Permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Senthilnathan, P., Palanivelu, C. (2015). Laparoscopic Pancreaticoduodenectomy. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1892-8

  • Online ISBN: 978-1-4939-1893-5

  • eBook Packages: MedicineMedicine (R0)