Abstract
Laparoscopic pancreatic surgery is evolving rapidly; however, the surgical treatment of periampullary tumors is still fraught with challenges, such as technical difficulty and the appropriateness of oncologic treatment for these patients. We describe how we performed laparoscopic pancreaticoduodenectomy (LPD) combined with minilaparotomy successfully in six consecutive patients. This procedure consisted of two surgical phases: safe laparoscopic surgery, including the Kocher maneuver, tunneling behind the pancreatic neck, and dissecting along the uncinate process with magnified vision; and a secure open approach with complete skeletonization of the hepatoduodenal ligament and alimentary tract reconstruction, performed similarly to conventional pancreaticoduodenectomy, under direct visualization through the minilaparotomy. By performing this procedure, we combined a safe and secure minilaparotomy approach under direct vision with a less invasive laparoscopic approach providing a magnified image. Our experience demonstrates that LPD combined with minilaparotomy is technically feasible for selected patients with periampullary tumors.
References
Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, et al. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery. 2005;137:597–605.
Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, et al. Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg. 2007;246:77–82.
Takaori K, Tanaigawa N. Laparoscopic pancreatic resection: the past, present, and future. Surg Today. 2007;37:535–45.
Ganger M, Pomp A. Laparoscopic pylorus-preserving pancreaticoduodenectomy. Surg Endosc. 1994;8:408–10.
Palanivelu C, Rajan PS, Rangarajan M, Vaithiswaren 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;16:731–40.
Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg. 2010;145:19–23.
Uyama I, Ogiwara H, Iida S, Takahara T, Furuta T, Kikuchi K. Laparoscopic minilaparotomy pancreaticoduodenectomy with lymphadenectomy using an abdominal wall-lift method. Surg Laparosc Endosc. 1996;6:405–10.
Kimura Y, Hirata K, Mukaiya M, Mizuguchi T, Koito K, Katsuramaki T. Hand-assisted laparoscopic pylorus-preserving pancreaticoduodenectomy for pancreas head disease. Am J Surg. 2005;189:734–7.
Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, et al. A totally laparoscopic pylorus-preserving pancreaticoduodenectomy and reconstruction. Surg Today. 2009;39:359–62.
Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.
Tang CL, Eu KW, Tai BC, Soh JG, MacHin D, Seow-Choen F. Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer. Br J Surg. 2001;88:801–7.
Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc. 2006;20:1045–50.
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;18:13–8.
Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, et al. Comparison of laparoscopic-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease. Am J Surg. 2009;198:445–9.
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Suzuki, O., Kondo, S., Hirano, S. et al. Laparoscopic pancreaticoduodenectomy combined with minilaparotomy. Surg Today 42, 509–513 (2012). https://doi.org/10.1007/s00595-011-0064-x
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DOI: https://doi.org/10.1007/s00595-011-0064-x