Minimally invasive pancreatoduodenectomy

Abstract

MIPD appears to provide similar perioperative and oncologic outcomes in selected patients, when performed at experienced, high-volume centers. Its overall role in pancreatoduodenectomy needs to be better defined. Improved training opportunities, registry participation and prospective evaluation are needed.

Propensity score‐matched analysis of early outcomes after laparoscopic‐assisted versus open pancreaticoduodenectomy

“…5 In terms of oncological outcomes, the current study showed no significant differences between LAPD and OPD with regards to number of lymph nodes retrieved and margin status, a finding that was in line with existing studies. The current matched study revealed lower respiratory complications and faster time to ambulation in the LAPD group, while existing analyses report a shorter hospital stay in MIPD as compared to OPD.…”

“…While minimally invasive pancreatic surgery is still not widely adopted, there are suggestions that similar advantages from laparoscopy seen in the other fields of general surgery can be conferred to pancreatic operations, possibly improving its morbidity rates. 5 While this could be partially attributed to smaller tumours selected for MIPD, the better visualization of blood vessels via the MIPD camera platform could possibly have allowed for improved surgical haemostasis. 20 Nevertheless, these studies remain retrospective in nature and the Dutch LEOPARD-1 21 and Swedish LAPOP (http://www.isrctn.com/ISRCTN26912858 estimated completion date in 2020) randomized controlled trials should provide a better platform for comparison between both modes of treatment.…”

“…Indeed, other comparative studies between MIPD and OPD have also consistently shown increased operative duration and high conversion rates of up to 40% in the MIPD arm. 5 The steep learning curve, coupled with the small margin of error afforded to this complex procedure, is one of the main reasons holding pancreatic surgeons back from adopting MIPD as the standard of care. Notably, the conversion rate of the LAPD group in the current study was only 5%, in which the case was converted due to an inadvertent duodenal tear.…”

“…Despite the greater surgical complexity, several studies have encouragingly demonstrated decreased intraoperative blood loss and transfusion requirements in the MIPD group, while maintaining comparable intra-operative morbidity and mortality. 5 While this could be partially attributed to smaller tumours selected for MIPD, the better visualization of blood vessels via the MIPD camera platform could possibly have allowed for improved surgical haemostasis. While the current study did not demonstrate any difference in terms of the intra-operative blood loss between LAPD and OPD, this could be a result of surgeons overcoming the learning curve at the initial phase.…”

“…3 Although several centres have since reported their respective experience and established its feasibility, MIPD continues to be a technically challenging surgical procedure in which its utility over OPD remains inconclusive. 4,5 While some studies comparing both approaches have suggested the benefits of decreased intra-operative blood loss and shorter hospital stay in the MIPD group, 5 others have considered its longer operative times and the higher rates of delayed gastric emptying (DGE) and post-pancreatectomy haemorrhage (PPH) in the laparoscopic sub-group as possible shortcomings. 6 Till date, there has only been one published randomized trial comparing both procedures and the aforementioned advantages of MIPD have mainly been derived from retrospective analyses that are potentially limited by the presence of selection biases in which only cases with favourable patient and tumour characteristics were selected for MIPD.…”