Laparoscopic vascular reconstruction among 114 total laparoscopic pancreatoduodenectomies

Abstract

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.