Laparoscopic Pancreatoduodenectomy

Abstract

In recent years, total laparoscopic pancreaticoduodenectomy (TLPD) has been introduced as a feasible alternative to open pancreaticoduodenectomy (OPD) when performed by experienced surgeons in laparoscopic and pancreatic surgery. Its application has been gradually increased, but its safety, reproducibility, and oncological outcomes are still debated due to its technical complexity and prolonged operating time. We performed a systematic analysis of the more relevant aspects of TLPD. In this chapter, we report a general overview of the different experiences present in the literature regarding indications, surgical techniques, postoperative outcomes, benefits and limitations of this approach, oncological results, learning curve, and costs. There is no standardized surgical technique for TLPD. Different techniques exist for both the demolitive stage and the reconstructive stage. We summarized the different aspects of the surgical technique based on the various experiences reported by different authors. Compared to OPD, TLPD provides the advantages of laparoscopy, i.e., reduced blood loss, decreased postoperative pain, and shorter length of hospital stay, without increasing the rate of postoperative complications or compromising oncological outcomes. An appropriate patient selection is crucial at the beginning of the learning curve. With increased experience, more challenging cases may also be approached with this technique, including those requiring major vascular resections or multi-visceral resections.