Laparoscopic Pancreaticoduodenectomy Through an Arterial Approach: A Report of 19 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LinHao-ming ¹ , LiGuo-lin ¹ , CHANGRui-ming ² , ZHOURui ¹ ,  MinJun ¹

1. Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China;
2. Emergency Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China;

Corresponding author：

MinJun, Email: doclein@gmail.com

Keywords：

Laparoscopy; Pancreaticoduodenectomy; Arterial approach

DOI：

10.7507/1007-9424.20140296

Video：

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Objective To introduce the method of laparoscopic pancreaticoduodenectomy through an arterial approach, and to evaluate the clinical value of this technique. Methods The clinical data of 19 patients with periampullary carcinoma, distal bile duct cancer, and early-stage pancreatic head carcinoma that underwent laparoscopic pancreaticoduodenectomy through an arterial approach in the Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen Memorial Hospital between September 2010 and July 2013 were retrospectively analyzed. The patients were followed-up until February 28, 2014. Results Laparoscopic pancreaticoduodenectomy were successfully performed in all 19 cases, there were no need to convert to open surgery. Open reconstruction was performed in 2 cases, and 17 cases underwent total laparoscopic reconstruction of the digestive tract. The duration of the operations ranged from 5-10.5 h(mean 6.3 h), and the intra-operative blood loss ranged from 170-430 mL(mean 250 mL). Post-surgical pathology detected a mean number of 13.7 lymph(9-21) nodes in all patients. No deaths occurred during the perioperative period. Complications were observed in 42.1%(8/19) of the subjects, including 5 cases with pancreatic fistula, 1 case with bile leak, 1 case with gastric emptying disorder, and 1 case with a gastroduodenal artery aneurysm. The mean length of hospital stay was 10.7 d(7-19 d). The mean followed-up period was 7.5 months(2-28 months), there were 6 patients died of tumor metastasis or recurrence during the followed-up. Conclusion Laparoscopic pancreaticoduodenectomy through an arterial approach simplifies pancreaticoduodenectomy and lymph node dissection procedures, and can completely remove lymph nodes.

Citation： LinHao-ming, LiGuo-lin, CHANGRui-ming, ZHOURui, MinJun. Laparoscopic Pancreaticoduodenectomy Through an Arterial Approach: A Report of 19 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(10): 1237-1240. doi: 10.7507/1007-9424.20140296 Copy

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2.	Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases[J]. Surg Endosc, 2006, 20(7):1045-1050.
3.	Pugliese R, Scandroglio I, Sansonna F, et al. Laparoscopic pancreaticoduodenectomy:a retrospective review of 19 cases[J]. Surg Laparosc Endosc Percutan Tech, 2008, 18(1):13-18.
4.	Corcione F, Pirozzi F, Cuccurullo D, et al. Laparoscopic pancreaticoduodenectomy:experience of 22 cases[J]. Surg Endosc, 2013, 27(6):2131-2136.
5.	刘兴国, 冉凌, 吴涛, 等.腹腔镜胰十二指肠切除术中肠系膜上血管的应用解剖[J].中国临床解剖学杂志, 2007, 25(2):172-175.
6.	杨学伟, 汪谦, Nimura Y, 等.标准和扩大淋巴结切除在胰头导管腺癌根治性胰十二指肠切除中的对比研究:一项日本多中心长期随机对照研究的长期结果[J].中华普通外科学文献:电子版, 2012, 6(3):254-263.
7.	李更天, 胡智明, 赵大建, 等.规范化区域淋巴结清扫在胰头癌胰十二指肠切除术中的临床意义[J].肝胆胰外科杂志, 2011, 23(5):369-372.
8.	张怡杰, 胡先贵, 唐岩, 等.区域淋巴结廓清在胰十二指肠切除术中的临床意义[J].中华外科杂志, 2003, 41(5):7-10.
9.	Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy[J]. HPB (Oxford), 2011, 13(7):454-458.
10.	Gagner M, Palermo M. Laparoscopic Whipple procedure:review of the literature[J]. J Hepatobiliary Pancreat Surg, 2009, 16(6):726-730.
11.	Palanivelu C, Jani K, Senthilnathan P, et al. Laparoscopic pancreaticoduodenectomy:technique and outcomes[J]. J Am Coll Surg, 2007, 205(2):222-230.
12.	Mesleh MG, Stauffer JA, Asbun HJ. Minimally invasive surgical techniques for pancreatic cancer:ready for prime time?[J]. J Hepatobiliary Pancreat Sci, 2013, 20(6):578-582.
13.	Giger U, Michel JM, Wiesli P, et al. Laparoscopic surgery for benign lesions of the pancreas[J]. J Laparoendosc Adv Surg Tech A, 2006, 16(5):452-457.
14.	Boggi U, Amorese G, Vistoli F, et al. Laparoscopic pancreatico-duodenectomy:a systematic literature review[J]. Surg Endosc, 2014 Aug 15.[Epub ahead of print].
15.	Kawaguchi M, Ishikawa N, Shimada M, et al. Laparoscopic pancreaticoduodenectomy after endovascular repair for abdominal aortic aneurysm[J]. Int J Surg Case Rep, 2013, 4(12):1117-1119.
16.	Cho A, Yamamoto H, Kainuma O. Tips of laparoscopic pancreaticoduodenectomy:superior mesenteric artery first approach (with video)[J]. J Hepatobiliary Pancreat Sci, 2014, 21(3):19-21.
17.	Cho A, Yamamoto H, Kainuma O, et al. Performing simple and safe dunking pancreaticojejunostomy using mattress sutures in purelaparoscopic pancreaticoduodenectomy[J]. Surg Endosc, 2014, 28(1):315-318.
18.	Mesleh MG, Stauffer JA, Bowers SP, et al. Cost analysis of open and laparoscopic pancreaticoduodenectomy:a single institution comparison[J]. Surg Endosc, 2013, 7(12):4518-4523.
19.	Jacobs MJ, Kamyab A. Total laparoscopic pancreaticoduodenectomy[J]. JSLS, 2013, 17(2):188-193.
20.	Tamura A, Otsuka Y, Tsuchiya M, et al. Laparoscopic surgery for pancreatic cancer[J]. Gan To Kagaku Ryoho, 2012, 39(3):351-356.
21.	Kendrick ML. Laparoscopic and robotic resection for pancreatic cancer[J]. Cancer J, 2012, 18(6):571-576.
22.	Boggi U, Signori S, De Lio N, et al. Feasibility of robotic pancreaticoduodenectomy[J]. Br J Surg, 2013, 100(7):917-925.
23.	Lee JS, Han JH, Na GH, et al. Laparoscopic pancreaticoduodenectomy assisted by mini-laparotomy[J]. Surg Laparosc Endosc Percutan Tech, 2013, 23(3):98-102.
24.	Ogiso S, Conrad C, Araki K, et al. Posterior approach for laparoscopic pancreaticoduodenectomy to prevent replaced hepatic artery injury[J]. Ann Surg Oncol, 2013, 20(9):3120.
25.	Gumbs AA, Rodriguez Rivera AM, Milone L, et al. Laparoscopic pancreatoduodenectomy:a review of 285 published cases[J]. Ann Surg Oncol, 2011, 18(5):1335-1341.

1. Ammori BJ, Ayiomamitis GD. Laparoscopic pancreaticoduodenectomy and distal pancreatectomy:a UK experience and a systematic review of the literature[J]. Surg Endosc, 2011, 25(7):2084-2099.
2. Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases[J]. Surg Endosc, 2006, 20(7):1045-1050.
3. Pugliese R, Scandroglio I, Sansonna F, et al. Laparoscopic pancreaticoduodenectomy:a retrospective review of 19 cases[J]. Surg Laparosc Endosc Percutan Tech, 2008, 18(1):13-18.
4. Corcione F, Pirozzi F, Cuccurullo D, et al. Laparoscopic pancreaticoduodenectomy:experience of 22 cases[J]. Surg Endosc, 2013, 27(6):2131-2136.
5. 刘兴国, 冉凌, 吴涛, 等.腹腔镜胰十二指肠切除术中肠系膜上血管的应用解剖[J].中国临床解剖学杂志, 2007, 25(2):172-175.
6. 杨学伟, 汪谦, Nimura Y, 等.标准和扩大淋巴结切除在胰头导管腺癌根治性胰十二指肠切除中的对比研究:一项日本多中心长期随机对照研究的长期结果[J].中华普通外科学文献:电子版, 2012, 6(3):254-263.
7. 李更天, 胡智明, 赵大建, 等.规范化区域淋巴结清扫在胰头癌胰十二指肠切除术中的临床意义[J].肝胆胰外科杂志, 2011, 23(5):369-372.
8. 张怡杰, 胡先贵, 唐岩, 等.区域淋巴结廓清在胰十二指肠切除术中的临床意义[J].中华外科杂志, 2003, 41(5):7-10.
9. Kendrick ML, Sclabas GM. Major venous resection during total laparoscopic pancreaticoduodenectomy[J]. HPB (Oxford), 2011, 13(7):454-458.
10. Gagner M, Palermo M. Laparoscopic Whipple procedure:review of the literature[J]. J Hepatobiliary Pancreat Surg, 2009, 16(6):726-730.
11. Palanivelu C, Jani K, Senthilnathan P, et al. Laparoscopic pancreaticoduodenectomy:technique and outcomes[J]. J Am Coll Surg, 2007, 205(2):222-230.
12. Mesleh MG, Stauffer JA, Asbun HJ. Minimally invasive surgical techniques for pancreatic cancer:ready for prime time?[J]. J Hepatobiliary Pancreat Sci, 2013, 20(6):578-582.
13. Giger U, Michel JM, Wiesli P, et al. Laparoscopic surgery for benign lesions of the pancreas[J]. J Laparoendosc Adv Surg Tech A, 2006, 16(5):452-457.
14. Boggi U, Amorese G, Vistoli F, et al. Laparoscopic pancreatico-duodenectomy:a systematic literature review[J]. Surg Endosc, 2014 Aug 15.[Epub ahead of print].
15. Kawaguchi M, Ishikawa N, Shimada M, et al. Laparoscopic pancreaticoduodenectomy after endovascular repair for abdominal aortic aneurysm[J]. Int J Surg Case Rep, 2013, 4(12):1117-1119.
16. Cho A, Yamamoto H, Kainuma O. Tips of laparoscopic pancreaticoduodenectomy:superior mesenteric artery first approach (with video)[J]. J Hepatobiliary Pancreat Sci, 2014, 21(3):19-21.
17. Cho A, Yamamoto H, Kainuma O, et al. Performing simple and safe dunking pancreaticojejunostomy using mattress sutures in purelaparoscopic pancreaticoduodenectomy[J]. Surg Endosc, 2014, 28(1):315-318.
18. Mesleh MG, Stauffer JA, Bowers SP, et al. Cost analysis of open and laparoscopic pancreaticoduodenectomy:a single institution comparison[J]. Surg Endosc, 2013, 7(12):4518-4523.
19. Jacobs MJ, Kamyab A. Total laparoscopic pancreaticoduodenectomy[J]. JSLS, 2013, 17(2):188-193.
20. Tamura A, Otsuka Y, Tsuchiya M, et al. Laparoscopic surgery for pancreatic cancer[J]. Gan To Kagaku Ryoho, 2012, 39(3):351-356.
21. Kendrick ML. Laparoscopic and robotic resection for pancreatic cancer[J]. Cancer J, 2012, 18(6):571-576.
22. Boggi U, Signori S, De Lio N, et al. Feasibility of robotic pancreaticoduodenectomy[J]. Br J Surg, 2013, 100(7):917-925.
23. Lee JS, Han JH, Na GH, et al. Laparoscopic pancreaticoduodenectomy assisted by mini-laparotomy[J]. Surg Laparosc Endosc Percutan Tech, 2013, 23(3):98-102.
24. Ogiso S, Conrad C, Araki K, et al. Posterior approach for laparoscopic pancreaticoduodenectomy to prevent replaced hepatic artery injury[J]. Ann Surg Oncol, 2013, 20(9):3120.
25. Gumbs AA, Rodriguez Rivera AM, Milone L, et al. Laparoscopic pancreatoduodenectomy:a review of 285 published cases[J]. Ann Surg Oncol, 2011, 18(5):1335-1341.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic Pancreaticoduodenectomy Through an Arterial Approach: A Report of 19 Cases

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