Laparoscopic pancreaticoduodenectomy in Brisbane, Australia: an initial experience

Abstract

LPD is a technically challenging operation with a steep learning curve. The early oncological outcomes appear satisfactory. It remains to be determined whether the minimally invasive approach to pancreaticoduodenectomy offers benefits to patients.

Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases

“…MIPD involves not only a difficult and complex resection phase but also requires arguably the even more technically demanding reconstruction phase, in particular the creation of a secure pancreato‐enteric anastomoses. Several authors have raised concerns about the potential increase in morbidity and even mortality, especially during the early learning phase. In the study by Kutlu et al , the advantages of LPD, such as shorter hospital stay and lower readmission rate, become apparent only in high‐volume institutions performing more than 25 cases per year .…”

“…However, of even greater concern was that the detrimental effect of lower case volume was exacerbated by the laparoscopic approach . These concerns are especially relevant for institutions in Southeast Asia and the Australasian region whereby truly high‐volume centres such as those in the United States or Korea may not exist . Hence, in order to overcome the large gap between the open and totally MIS approach, many surgeons have proposed the hybrid technique, which has been shown to be a safe approach for surgeons first transitioning from OPD to MIPD .…”

“…Presently, although several large series reporting on minimally invasive PD (MIPD) have been reported from various countries world‐wide, there have been limited studies with a small sample size from Southeast Asia and Australasia on the applicability of MIPD in the region . In this study, we report our early experience with laparoscopic surgery (LS) and RS for periampullary tumours to determine its feasibility and safety.…”

“…Pancreatoduodenectomy (PD) is frequently the treatment of choice for tumours involving the periampullary region. Even today, PD is widely regarded as one of the most technically complicated and high‐risk abdominal operations and is still most frequently performed via the traditional open approach . Hence, although minimally invasive surgery (MIS) has been rapidly and widely adopted for various complicated abdominal procedures, including colectomies and hepatectomies, its application for the treatment of periampullary tumours, especially PD, remains limited today.…”

First experience with robotic pancreatoduodenectomy in Singapore

“…(25) Real concerns have been raised about the potential increase in morbidity and even mortality, especially during the early learning phase, with several authors having reported a high major morbidity rate during their early learning experience. (8,26) To overcome the large gap between the open and totally laparoscopic approaches, many surgeons have adopted the hybrid technique, which has been shown to be a safe 'in-between' approach for surgeons first embarking on LPD. (10,11,27) The introduction of robotic technology in the early 2000s was one of the greatest advancements for MIS over the past 20 years.…”