Total Laparoscopic Pancreaticoduodenectomy: A Single-Institutional Experience

Introduction: Laparoscopic pancreaticoduodenectomy represents one of the most advanced abdominal surgical procedures; however, a standard approach is still lacking. We present our initial experience with total laparoscopic pancreaticoduodenectomy (TLPD) with a video of the technique that we have developed and the clinical as well as oncologic outcomes obtained with this technique. Methods: This was a retrospective review of all cases consecutively performed by two operators between January 2013 and December 2014 at The University of Colorado (Fig. 1).[Figure not available: see fulltext.] Results: Thirty patients underwent TLPD; conversion to open procedure was required in two cases (6 %). Median age at diagnosis was 63.1 years [interquartile range (IQR) 53.8–70.8]. Operative characteristics and postoperative complications are summarized in Table 1. The operative time decreased from 366 minutes (IQR 320–421) in the first 15 cases to 312 min (IQR 282–372) in the second 15 cases (r = −2.7; p = 0.047). The estimated blood loss decreased from 300 mL (IQR 300–500) in the first 15 cases to 200 mL (IQR 150–375) in the second 15 cases (r = −6.3; p = 0.314).Table 1 Conclusions: Laparoscopic pancreaticoduodenectomy is a challenging operation, which is not performed in high volume at most centers. As a new laparoscopic pancreas program, our experience shows that oncologic outcomes are acceptable in terms of margin and lymph node harvest. There is undoubtedly a steep learning curve that complicates the initial application of TLPD; however, with the techniques displayed in this video many of the early complications can be overcome. Further study to evaluate for long-term safety is needed.