In our experience, LPD with concomitant major venous resection is feasible even in cases of longitudinal venous invasion. Further studies are needed to evaluate the role of laparoscopy in borderline pancreatic cancer.

Introduction There are limited numbers of high-volume centers performing minimally invasive pancreatoduodenectomy (MIPD) routinely. Several approaches to MIPD have been described. Aim of this analysis was to show the learning curve of three different approaches to MIPD. Focus was on determining the number of cases necessary to obtain proficient level in MIPD. Patients and methods Retrospective study wherein outcomes of 300 consecutive patients at three centers-at each center the initial 100 consecutive patients undergoing MIPD for malignant and benign tumors of the head of the pancreas and perimpullary area, performed by three experienced surgeons were collected and analyzed. Results Overall, 300 patients after MIPD were included: the three different cohorts (laparoscopic n = 100, hybrid n = 100, robotic n = 100). CUSUM analysis of operating time in each center demonstrated that the plateau for laparoscopic PD was n = 61, for hybrid PDes was n = 32 and for robotic PD was n = 68. Median operative time for laparoscopic, hybrid, and robotic approaches was 395 min, 404 min, 510 min, respectively. Intraoperative blood loss for laparoscopic PD, hybrid PD, and robotic PD was 250 ml, 250 ml, and 413 ml, respectively. Delayed gastric emptying occurred 12% in laparoscopic cohort, 10% in hybrid, and 53% in robotic cohort. Major complications (Clavien-Dindo III/IV) rate for laparoscopic PD, hybrid PD, and robotic PD was 32%, 37%, and 22% with 5% death in each cohorts, respectively. Conclusion This analysis of the learning curve of three European centers found a shorter learning curve with hybrid PD as compared to laparoscopic and robotic PD. In implementation of a MIPD program, a stepwise approach might be beneficial.

Introduction:Due to anatomical and functional specifics of the pancreas, its surgery emerged somewhat later than that of other areas of abdominal surgery, i.e. in the last 25 to 30 years of the last century. Minimally invasive laparoscopic interventions on the pancreas are still used insufficiently.Aim: To evaluate an 11-year experience of various laparoscopic interventions in the pancreas accumulated by one surgical team.Materials and methods:From November 2007 to May 2018, 371 patients (153 male and 218 female) underwent various laparoscopic pancreatic procedures for cancers of the biliopancreatoduodenal zone (n = 260), benign pancreatic tumors (n = 37), and chronic pancreatitis (n = 74). We performed 245 laparoscopic pancreaticoduodenal resections, 52  laparoscopic distal resections (LDR), 35  laparoscopic Frey procedures (FP), 18  laparoscopic total duodenopancreatectomies, 8  laparoscopic longitudinal pancreaticojejunostomies (LLPJ), 8 laparoscopic cystoenterostomies (LCE), 3 enucleations, and 2 Beger procedures (BP).Results:Laparoscopic gastropancreatoduodenal resection was performed in 197 (80.4%) cases and pylorus preserving pancreatoduodenal resection in 48 (19.6%) cases. The duration of the procedures was 412 ± 101  minutes, with blood loss volume of 220 ± 152 ml, and postoperative hospital stay of 19 ± 9 days. LDR was done laparoscopically in 50 (96.2%) patients; its duration was 228 ± 74 minutes, blood loss 40 ± 50  ml, and postoperative hospital stay 8 ± 5 days. FP, LLPJ, BP, and LCE were performed laparoscopically in 53  (93%) cases. FP lasted for 436 ± 95, LLPJ for 406 ± 82, BP for 585 ± 134, and LCE for 327 ± 90 minutes. The respective volumes of blood loos were 227 ± 217 mL in FP, 150 ± 156 mL in LLPJ, 175 ± 106 mL in BP, and 60 ± 90 mL in LCE. The postoperative hospital stay lasted for 8 ± 4 days after FP, 9 ± 7 days after LLPJ, 4.5 ± 0.7 days after BP, and 10 ± 9 days after LCE.Conclusion:Laparoscopic surgery of the pancreas is associated with minimal blood loss, absence of wound infection, and more rapid patient activation and rehabilitation. Compliance with the necessary requirements to implementation of laparoscopic technologies in high-volume centers should improve surgical results.

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This pan-European multicenter propensity score matched study found, among selected patients, a lower 90-day postoperative major morbidity after minimally invasive total pancreatectomy (MITP) as compared to open total pancreatectomy (OTP) with similar 90day mortality and survival.

The accumulation of experience performing laparoscopic procedures adopted to illustrate using the learning curve. The literature describes several models to represent the dynamics of the accumulation of experience in the evaluation of various minimally invasive procedures. However, there is no single objective method for the construction of a learning curve. To date, the learning curve for laparoscopic pancreatoduodenectomy (LDPR), one of the most complex operations in abdominal surgery, not widely described in the literature. Several models for the construction of a learning curve: a linear function and non-linear regression, exponential model, the spline regression and risk of failure coupled analysis of the cumulative sum amount. According to a graphical analysis of the learning curve LDPR ends in 47 operations.

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Introduction: Laparoscopic pancreatic surgery remains one of the most difficult and challenging applications of minimally invasive surgical approaches in spite of great development of these techniques nowadays. Patients and methods: One hundred and thirty one patients with periampullar tumors that planed for laparoscopic Whipple procedure (LPD) between January 2007 and July 2015 were analyzed. In cases when the SMV/PV resection was necessary due to tumor invasion it was performed. Results: One hundred and fourteen consecutive total laparoscopic PD were successfully performed. There were 66 females and 48 males. The mean age was 61 AE 10.9 years. Median BMI 24kg/m2 (range 16 to 37 kg/m2). Fourteen patients (12%) were operated on for benign and 100 (88%) for malignant lesions. Standard Whipple (n69;60%patients), pylorus-preserving PD (n45;40%patients. Median OT was 415min (range 240e 765min). Median blood lossÀ200ml (range 50e2100 ml). Clinical significant pancreatic fistula (n20;17%patients); grade B (n14;12% patients, grade C (n6;5%patients). Delayed gastric emptying grade B (n5;4,5% patients), grade C (n5;4,5% patients) patients. Postpancreatectomy haemorrhage grade A (n2;1,7% patients), grade B (n8;7% patients, grade C (n3;2,6% patients). Pancreatic adenocarcinoma (n59;51.9%), ampullary adenocarcinoma (n27;23.9%), chronic pancreatitis (n12;10.6%), common bile duct carcinoma (n8;7.1%), IPMN (n2;1.7%), duodenal adenoma (n1;0.8%), undifferentiated cancer of pancreas (n1;0.8%), undifferentiated cancer of common bile duct (n1;0.8%), undifferentiated cancer of duodenum (n1;0.8%), neuroendocrine carcinoma (n1;0.8%), solid pseudopapillary tumor (n1;0.8%). Eight patients had different types of venous resections. Conclusion: Total LPD demands high technical skills from the whole surgical team. Morbidity and mortality are the same like in open procedures, time of the operation is higher at the initial experience and becomes practically equal after performing 50 cases. Major venous reconstruction is possible if needed.