Major venous resection and reconstruction using a minimally invasive approach during laparoscopic pancreaticoduodenectomy: One step forward

Senthilnathan, Palanisamy; Deuri, Biswajit; Naidu, Subrahmaneswara Babu; Palanisamy, N.; Natesan, Anand Vijay; Palanivelu, Praveen Raj; Parthasarathy, R.; Palanivelu, Chinnusamy

doi:10.1111/ases.12208

Cited by 20 publications

(10 citation statements)

References 10 publications

(7 reference statements)

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“…As early as 2011, Kendrick and colleagues reported the initial experience of major venous resection during total laparoscopic pancreatoduodenectomy, which first demonstrated the feasibility of this technique. [26] Later on, Panalivelu [13] reported a case that underwent laparoscopic end-to-end anastomosis, and Dokmak [14] reported a case that underwent laparoscopic partial venous excision using a patch, respectively. Recently, Khatkov demonstrated the feasibility and safety of laparoscopic pancreatoduodenectomy with venous reconstruction in eight patients.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft

Wang

Cai²,

Zhao

et al. 2019

Medicine

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Rationale:With the development of laparoscopic techniques, laparoscopic pancreatoduodenectomy was applied in various indications including pancreatic cancer. Here, we share our experience of venous resection and reconstruction with interposition graft in laparoscopic pancreatoduodenectomy in these patients.Patient concerns:We reviewed data of laparoscopic pancreatoduodenectomy with venous resection and reconstruction in patients with pancreatic cancer between the dates of October 2010 and November 2017.Outcomes:Ten patients underwent laparoscopic pancreatoduodenectomy with portal-superior mesenteric vein resection and reconstruction with interposition graft. The mean operative time was 547 min. The mean blood loss was 435 ml. The mean length of venous defect after resection was 5.4 cm. R0 resection was achieved in nine patients (90%). There was one patient who suffered from severe postoperative complication. There was no 30-day mortality in this study. The long-term patency was achieved in all patients.Conclusion:In this study, we demonstrate the initial experience of laparoscopic pancreaticoduodenectomy with long venous resection and reconstruction. Although applied in small number of patients, it could be another option for well-selected patients with reasonable morbidity and mortality as well as long-term outcomes in experienced minimally invasive surgical team.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft

Wang

Cai²,

Zhao

et al. 2019

Medicine

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“…In recent years, studies from multiple centers have shown that, compared with PD, the incidences of intraoperative bleeding, postoperative incision-related complications, and hospital stay in LPD are lower, while the incidences of severe complications, such as hemorrhage and pancreatic fistula, are not significantly higher. The value of LPD in practical application has been confirmed[14-16]. For patients with tumor invasion of the portal vein/SMV, the range of LPD resection and dissection can reach the standard PD level[16-18].…”

Section: Discussionmentioning

confidence: 99%

“…The value of LPD in practical application has been confirmed[14-16]. For patients with tumor invasion of the portal vein/SMV, the range of LPD resection and dissection can reach the standard PD level[16-18]. The incidence of postoperative complications and mortality are not significantly increased, giving LPD a certain advantage over PD[19].…”

Section: Discussionmentioning

confidence: 99%

Repair of the portal vein using a hepatic ligamentum teres patch for laparoscopic pancreatoduodenectomy: A case report

Wei¹,

Chen²,

Guan³

et al. 2019

WJCC

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BACKGROUNDLaparoscopic pancreatoduodenectomy (LPD) has been developed gradually with the advances in surgical laparoscopic techniques. It is technically challenging to perform LPD with portal vein resection and reconstruction.CASE SUMMARYA 71-year-old female patient was diagnosed with distal cholangiocarcinoma. After preoperative examination and rigorous preoperative preparation, the patient underwent LPD using 3D laparoscopy on July 17, 2018. During the surgery, we found that the tumor invaded the right wall of the portal vein; thus, pancreaticoduodenectomy combined with partial portal vein wall resection was performed. The defect of the portal vein wall was approximately 2.5 cm × 1.0 cm. The hepatic ligamentum teres was excised by laparoscopy and then recanalized in vitro. Following recanalization, the hepatic ligamentum teres was cut longitudinally and then trimmed into vascular patches that were then used to reconstruct the defect of the portal vein through 3D laparoscopy. The operative time was 560 min, and intraoperative blood loss was 100 mL. The duration of the blood occlusion time was 63 min. No blood transfusion was required. The patient underwent enhanced recovery after surgery procedures after the operation. The patient was discharged on postoperative day 11. Follow-up for 6 months after discharge showed no stenosis of the portal vein and good patency of blood flow.CONCLUSIONIt is safe and feasible to use the hepatic ligamentum teres patch to repair portal vein in LPD. However, the long-term patency of this technique for venous reconstruction requires further investigation.

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“…However, few studies have reported the technical and oncological feasibility of LPD combined with venous vascular resection 11121314151617. In the current report, we present the case of a patient with pancreatic head cancer who underwent successful LPD with segmental resection of the SMV–SV–PV confluence, resulting in negative surgical margins.…”

Section: Introductionmentioning

confidence: 92%

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

Park

Kang

2018

Ann Hepatobiliary Pancreat Surg

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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.

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Major venous resection and reconstruction using a minimally invasive approach during laparoscopic pancreaticoduodenectomy: One step forward

Cited by 20 publications

References 10 publications

Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft

Laparoscopic pancreatoduodenectomy combined with portal-superior mesenteric vein resection and reconstruction with interposition graft

Repair of the portal vein using a hepatic ligamentum teres patch for laparoscopic pancreatoduodenectomy: A case report

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

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