Laparoscopic pancreaticoduodenectomy with segmental resection of superior mesenteric vein-splenic vein-portal vein confluence in pancreatic head cancer: can it be a standard procedure?

Abstract

The feasibility of laparoscopic pancreaticoduodenectomy (LPD) in the treatment of pancreatic cancer is still disputed. However, advances in surgical technique and accumulating experience have led to the use of LPD with combined vascular resection and reconstruction as a safe and feasible procedure, especially in pancreatic cancer with major vascular involvement. A 64-year-old woman presented with obstructive jaundice secondary to pancreatic head cancer. Contrast abdominopelvic computed tomography revealed a pancreatic head tumor measuring approximately 22 mm in diameter that was abutting the first jejunal branch of the superior mesenteric vein at an angle of <180°. The patient underwent LPD, which failed to resect the pancreatic head tumor invading the superior mesenteric vein. Consequently, segmental resection of the confluence of the superior mesenteric vein, splenic vein, and portal vein (SMV/SV/PV) was completely performed in laparoscopic approach without complication. The patient recovered without any event and was discharged on postoperative day 9. LPD combined with vascular resection and reconstruction is feasible in cases involving major blood vessels. Further surgical expertise and education are required before LPD can be used as a standard procedure.

First experience of pancreaticoduodenectomy using Revo-i in a patient with insulinoma

“…The laparoscopic resection technique used in our institution had been previously published. 20 The to-tal operation time for laparoscopic resection was 3 hours and 30 minutes, and the Revo-i robotic surgical system was docked (Fig. 2A).…”

Is Laparoscopic Pancreaticoduodenectomy Feasible for Pancreatic Ductal Adenocarcinoma?

“…Until now, only a few case reports [ 58 , 59 , 60 , 61 , 62 ] and case series [ 19 , 63 , 64 , 65 ] have been reported on the technical feasibility and safety of LPD with combined venous vascular resection (LPD-VR, Table 4 ). Tangential resection with stapler or hand suture or patch reconstruction appears to be common among the patients with LPD-VR ( Figure 3 ), which is also confirmed when comparing with OPD-VR [ 19 ].…”

Pitfalls for laparoscopic pancreaticoduodenectomy: Need for a stepwise approach

“…For patient safety, failure to progress within 1 hour of dissection as a result of severe pancreatitis or adhesions, unexpected vascular invasion, unexpected adjacent organ involvement requiring combined organ resection, unusual vascular anatomy, and uncontrolled bleeding may warrant open conversion to laparotomy . Although combined segmental resection of the major venous system is feasible and safe, only expert surgeons can carry out this difficult intraoperative situation to complete a safe and successful Lap PD. Figure illustrates the indications and basis for selection of Lap PD.…”

“…Recently, we began to explore the feasibility of laparoscopic pancreaticoduodenectomy for treating periampullary tumor and began to standardize our surgical technique . In our center, to augment hepatobiliary surgical training, we strictly implemented video review and analysis, practice training and simulation, operating room didactics, and strict implementation of our stepwise approach in Lap PD.…”