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Laparoscopic Pancreaticoduodenectomy

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Abstract

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.

Keywords

  • Pancreatic cancer
  • Periampullary cancer
  • Laparoscopic

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Authors and Affiliations

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

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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.

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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. https://doi.org/10.1007/978-1-4939-1893-5_11

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  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_11

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