Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience

Kim, Song C.; Song, Ki Byung; Jung, Yuh‐Seog; Kim, Young H.; Park, Do H.; Lee, Sang S.; Seo, Dong Wan; Lee, Sung K.; Kim, Myung‐Hee Y.; Park, Kwang M.; Lee, Young Jong

doi:10.1007/s00464-012-2427-9

Cited by 180 publications

(137 citation statements)

References 20 publications

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“…Since then, several single institution series reported on the safety and feasibility of TLP in the setting of several benign and malignant pancreatic pathologies (2)(3)(4). The available literature mainly focuses on two key aspects of TLP, one being the learning curve necessary to master the procedure and the other being the comparison of overall outcomes between TLP and open pancreaticoduodenectomy (OPD) (5)(6)(7). The numerous studies that have focused on TLP learning curve have identified at least three phases: a slow difficult beginning, followed by a rapid improvement that culminates in a plateau phase characterized by a slow but continuous improvement (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

“…The available literature mainly focuses on two key aspects of TLP, one being the learning curve necessary to master the procedure and the other being the comparison of overall outcomes between TLP and open pancreaticoduodenectomy (OPD) (5)(6)(7). The numerous studies that have focused on TLP learning curve have identified at least three phases: a slow difficult beginning, followed by a rapid improvement that culminates in a plateau phase characterized by a slow but continuous improvement (5)(6)(7). Moreover, most studies comparing TLP to OPD suggest that when TLP is performed in center of expertise the oncologic outcome, the complication rate, and the mortality rate are similar to OPD.…”

Section: Introductionmentioning

confidence: 99%

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Total laparoscopic pancreaticoduodenectomy

et al. 2016

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Total laparoscopic pancreaticoduodenectomy (TLP) represents perhaps one of the most challenging abdominal operations. This procedure is gaining popularity in recent years, mostly due to the numerous reports underling its safety and feasibility in the setting of several benign and malignant pancreatic pathologies. Minimal-invasive pancreatic surgery is rapidly becoming a reality in many centers around the globe and its benefits, compared to the traditional open approach, have been extensively proven in the setting of distal pancreatic resection. The many advantages of a laparoscopic approach, such as the improved visual magnification, the theoretical improved tissue exposure, and the potential for a more delicate manipulation of tissues are reasonably expected to be applicable to other pancreatic procedures including TLP. Herein we describe a technique for a TLP; we provide some suggestions on patient selection, pre-operative preparation, equipment, postoperative management, and finally discuss some of the most common pitfalls encountered during the procedure. preparation, equipment, postoperative management, and finally discuss some of the most common pitfalls encountered during the procedure. Patient selection and workupMost patients with pancreatic, ampullary, or biliary pathologies who require a pancreaticoduodenectomy are eligible for a laparoscopic approach. One limitation is represented by patients with locally advanced pathologies (i.e., locally advanced pancreatic adenocarcinoma) with involvement of the mesenteric vasculature due to the inherent technical difficulties represented by the need for laparoscopic vascular resection and reconstruction (although a few specialized centers occasionally offer TLP in this setting) (11,19).The authors routinely obtain preoperative multi-slice pancreas specific triple-phase (i.e., arterial, late arterial, and venous phase) computed tomography in order to properly evaluate the pancreatic gland and its spatial relation with the surrounding organs and vasculature; particular attention is given to the evaluation for any aberrant anatomy (e.g., replaced or accessory hepatic vasculature).Additional imaging is dictated by the particular pancreatic pathology that is being addressed, and can vary from endoscopic retrograde cholangiopancreatography with or without pancreatic duct brushing, endoscopic pancreatic ultrasound with or without fine needle aspiration, and magnetic resonance imaging.Preoperative laboratory tests are routinely obtained and include a complete blood cell count, a complete metabolic panel (CMP), a coagulation profile, and in case of a patient with known preexisting diabetes glycated hemoglobin level is assessed; specific tumors markers are obtained based on the pathology being treated. Pre-operative preparationPatients selected to undergo a TLP meet preoperatively with a nutritionist and a glucose management expert, this provides an initial overview on the life style and diet adjustments that are necessary following the procedure. Furthermore, t...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Total laparoscopic pancreaticoduodenectomy

et al. 2016

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“…To date, only a handful of laparoscopic pancreatic resection series have been published and very few of them report more than 50 cases [1][2][3][4][5][6][7][8][9][10]. Gagner et al [11] previously presented work on laparoscopic pancreatic head resections, but such small series have remained substantially experimental.…”

Section: Introductionmentioning

confidence: 99%

Robotic‐assisted pancreatic surgery

Fernandes

Giulianotti

2013

J Hepato Biliary Pancreat

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Background Pancreatic surgery is a challenging application of minimally invasive surgery. Due to the complexity of the surgical technique, requiring dissection along major abdominal vessels as well as delicate reconstruction involving biliary, pancreatic and enteric anastomoses, reports on laparoscopic pancreatic surgery have been scanty. With the advent of robotic-assisted surgery, however, the increased dexterity granted by endo-wristed instruments, the improved three-dimensional vision and the computer filtration of the surgeon's movements have brought minimally invasive pancreatic surgery into a new era. Methods As the surgical group which has performed the highest number of robotic-assisted pancreatic procedures worldwide, we review the state of the art of minimally invasive robotic-assisted pancreatic surgery. Clinical results from all major robotic-assisted pancreatic surgery series are considered. Results Preliminary reports from the published major pancreatic surgery series show encouraging results, with morbidity and mortality comparable to open surgery. Preliminary data on cancer survival rates also appear to be similar to open series. Conclusion Robotic-assisted pancreatic surgery is safe and feasible for all pancreatic diseases. The complexity of pancreatic procedures warrant them to be carried out in specialised centres, where short-and long-term outcomes seem to be similar to the ones achieved in open surgery.

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“…в своей серии из 100 после-довательно оперированных пациентов показали ди-намику накопления опыта в виде графика линейной регрессии, а также выделили три периода по 33, 33 и 34 пациента соответственно для иллюстрации дина-мики средних значений продолжительности опера-ции, послеоперационного койко-дня и т.д. [9]. Не-достатком данной работы явилось необоснованное подразделение на периоды.…”

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“…Не-достатком данной работы явилось необоснованное подразделение на периоды. Авторы не указывают минимальное количество операций, необходимое для освоения метода [9].…”

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Optimal model of learning curve through the example of laparoscopic pancreatoduodenectomy

Тютюнник¹,

Tyutyunnik²,

Khatkov³

et al. 2015

Endosk. khir.

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The accumulation of experience performing laparoscopic procedures adopted to illustrate using the learning curve. The literature describes several models to represent the dynamics of the accumulation of experience in the evaluation of various minimally invasive procedures. However, there is no single objective method for the construction of a learning curve. To date, the learning curve for laparoscopic pancreatoduodenectomy (LDPR), one of the most complex operations in abdominal surgery, not widely described in the literature. Several models for the construction of a learning curve: a linear function and non-linear regression, exponential model, the spline regression and risk of failure coupled analysis of the cumulative sum amount. According to a graphical analysis of the learning curve LDPR ends in 47 operations.

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Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience

Abstract: The LPPPD procedure is technically safe and feasible, with an acceptable rate of morbidity and other clinical outcomes for benign and malignant diseases. Clinical outcomes can be improved once a learning curve has been overcome.

Cited by 180 publications

References 20 publications

Total laparoscopic pancreaticoduodenectomy

Total laparoscopic pancreaticoduodenectomy

Robotic‐assisted pancreatic surgery

Optimal model of learning curve through the example of laparoscopic pancreatoduodenectomy

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