Preliminary experience of “counter clockwise resection” in total laparoscopic pan-creaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XU Jin , XU Weixue , XING Jian , ZHANG Weiming , WANG Hainan

Department of Pancreatic Surgery, Affiliated Shengjing Hospital of China Medical University, Shenyang 110004, P. R. China;

Corresponding author：

XU Jin, Email: xujinwang@163.com

Keywords：

pancreaticoduodenectomy; laparoscope; counter clockwise resection

DOI：

10.7507/1007-9424.201702006

Video：

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ObjectiveTo discuss application of " counter clockwise resection” in total laparoscopic pan-creaticoduodenectomy (TLPD) and summarize it’s preliminary experiences.MethodThe clinical data of consecutive 8 patients underwent TLPD in the Department of Pancreatic Surgery, Affiliated Shengjing Hospital of China Medical University from July 2016 to January 2017 were analyzed retrospectively.ResultsThere were 3 males and 5 females in these 8 patients. The age was (64.13±15.01) years. The results of postoperative pathology included 1 duodenal cancer, 2 distal biliary tract cancers, 4 pancreatic head cancers, and 1 solid pseudopapillary tumor of pancreatic head. All the 8 patients were performed with TLPD successfully, and the time of the operation was (527.50±69.44) min, the resection time of the specimen was (241.25±38.71) min, and the blood loss was (368.75±162.43) mL, the postoperative hospitalization stay was (18.67±4.00) d. There were no postoperative bleeding, perioperative death, and delayed gastric emptying．Four patients suffered from the pancreatic fistula including 3 cases of grade A and 1 case of grade B pancreatic fistulas, and 1 case suffered from the intra-abdominal infection, who were cured after the conservative treatment. All the patients were following-up, and there was no abnormality.ConclusionPreliminary results of limited cases in this study show that " counter clockwise resection” might be a safe, effective, and easy method of TLPD, but further research is need to study.

Citation： XU Jin, XU Weixue, XING Jian, ZHANG Weiming, WANG Hainan. Preliminary experience of “counter clockwise resection” in total laparoscopic pan-creaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(9): 1090-1094. doi: 10.7507/1007-9424.201702006 Copy

1.	Burkhart RA, Javed AA, Ronnekleiv-Kelly S, et al. The use of negative pressure wound therapy to prevent post-operative surgical site infections following pancreaticoduodenectomy. HPB (Oxford), 2017 Jun 8. S1365-182 X(17) 30595-6. [Epub ahead of print].
2.	Bergquist JR, Shubert CR, Ubl DS, et al. Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program. HPB (Oxford), 2016, 18(11): 900-907.
3.	Njoku VC, Howard TJ, Shen C, et al. Pyogenic liver abscess following pancreaticoduodenectomy: risk factors, treatment, and long-term outcome. J Gastrointest Surg, 2014, 18(5): 922-928.
4.	Jaap K, Hunsinger M, Dove J, et al. Morphometric predictors of morbidity after pancreatectomy. Am Surg, 2016, 82(12): 1221-1226.
5.	Gleeson EM, Shaikh MF, Shewokis PA, et al. WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database. Surgery, 2016, 160(5): 1279-1287.
6.	Zouros E, Liakakos T, Machairas A, et al. Fast-track pancreaticoduodenectomy in the elderly. Am Surg, 2017, 83(3): 239-249.
7.	Adam MA, Thomas S, Youngwirth L, et al. Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg, 2017, 152(4): 336-342.
8.	Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
9.	卢榜裕, 陆文奇, 蔡小勇, 等. 腹腔镜胰十二指肠切除治疗十二指肠乳头癌一例报告. 中国微创外科杂志, 2003, 3(3): 197-198.
10.	Adam MA, Choudhury K, Dinan MA, et al. Minimally invasive versus open pancreaticoduodenectomy for cancer: Practice patterns and short-term outcomes among 7 061 patients. Ann Surg, 2015, 262(2): 372-377.
11.	Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg, 2010, 145(1): 19-23.
12.	Palanivelu C, Rajan PS, Rangarajan M, et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg, 2009, 16(6): 731-740.
13.	Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg, 2012, 215(6): 810-819.
14.	Zureikat AH, Moser AJ, Boone BA, et al. 250 robotic pancreatic resections: safety and feasibility. Ann Surg, 2013, 258(4): 554-562.
15.	Kim SC, Song KB, Jung YS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc, 2013, 27(1): 95-103.
16.	Chalikonda S, Aguilar-Saavedra JR, Walsh RM. Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc, 2012, 26(9): 2397-2402.
17.	Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Surg Endosc, 2006, 20(7): 1045-1050.
18.	Pugliese R, Scandroglio I, Sansonna F, et al. Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech, 2008, 18(1): 13-18.
19.	Bencini L, Annecchiarico M, Farsi M, et al. Minimally invasive surgical approach to pancreatic malignancies. World J Gastrointest Oncol, 2015, 7(12): 411-421.
20.	中华医学会外科学分会胰腺外科学组, 中国医疗保健国际交流促进会胰腺病分会胰腺微创治疗学组, 中国研究型医院学会胰腺疾病专业委员会胰腺微创学组, 等. 腹腔镜胰十二指肠切除手术专家共识(附: 手术流程与主要步骤). 中华外科杂志, 2017, 55(5): 335-339.
21.	Jacobs MJ, Kamyab A. Total laparoscopic pancreaticoduodenectomy. JSLS, 2013, 17(2): 188-193.
22.	鲁超, 金巍巍, 牟一平, 等. 腹腔镜胰十二指肠切除术的学习曲线. 外科理论与实践, 2015, 20(6): 485-489.
23.	林浩铭, 李国林, 常瑞明, 等. 动脉入路腹腔镜胰十二指肠切除 19 例报道. 中国普外基础与临床杂志, 2014, 21(10): 1237-1240.
24.	孙跃明, 苗毅. 腹腔镜胰十二指肠切除术应用及其评价. 中国实用外科杂志, 2010, 30(3): 190-192.
25.	洪德飞, 张宇华, 张成武, 等. 腔镜胰十二指肠切除术在壶腹周围癌中的应用. 中国普外基础与临床杂志, 2016, 23(4): 393-397.
26.	张华, 王明俊, 王昕, 等. 腹腔镜胰十二指肠切除术 45 例体会. 中国普外基础与临床杂志, 2014, 21(8): 940-945.
27.	李敬东, 李勇, 冷政伟, 等. 缩短腹腔镜胰十二指肠切除术学习曲线的经验. 中国普外基础与临床杂志, 2016, 23(4): 398-402.
28.	金巍巍, 徐晓武, 牟一平, 等. 腹腔镜胰十二指肠切除术 66 例初步经验总结. 中华外科杂志, 2016, 54(2): 84-88.
29.	金巍巍, 徐晓武, 牟一平, 等. 腹腔镜胰十二指肠切除术单中心 233 例临床经验总结. 中华外科杂志, 2017, 55(5): 354-358.
30.	Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.

1. Burkhart RA, Javed AA, Ronnekleiv-Kelly S, et al. The use of negative pressure wound therapy to prevent post-operative surgical site infections following pancreaticoduodenectomy. HPB (Oxford), 2017 Jun 8. S1365-182 X(17) 30595-6. [Epub ahead of print].
2. Bergquist JR, Shubert CR, Ubl DS, et al. Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program. HPB (Oxford), 2016, 18(11): 900-907.
3. Njoku VC, Howard TJ, Shen C, et al. Pyogenic liver abscess following pancreaticoduodenectomy: risk factors, treatment, and long-term outcome. J Gastrointest Surg, 2014, 18(5): 922-928.
4. Jaap K, Hunsinger M, Dove J, et al. Morphometric predictors of morbidity after pancreatectomy. Am Surg, 2016, 82(12): 1221-1226.
5. Gleeson EM, Shaikh MF, Shewokis PA, et al. WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database. Surgery, 2016, 160(5): 1279-1287.
6. Zouros E, Liakakos T, Machairas A, et al. Fast-track pancreaticoduodenectomy in the elderly. Am Surg, 2017, 83(3): 239-249.
7. Adam MA, Thomas S, Youngwirth L, et al. Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg, 2017, 152(4): 336-342.
8. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
9. 卢榜裕, 陆文奇, 蔡小勇, 等. 腹腔镜胰十二指肠切除治疗十二指肠乳头癌一例报告. 中国微创外科杂志, 2003, 3(3): 197-198.
10. Adam MA, Choudhury K, Dinan MA, et al. Minimally invasive versus open pancreaticoduodenectomy for cancer: Practice patterns and short-term outcomes among 7 061 patients. Ann Surg, 2015, 262(2): 372-377.
11. Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg, 2010, 145(1): 19-23.
12. Palanivelu C, Rajan PS, Rangarajan M, et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg, 2009, 16(6): 731-740.
13. Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg, 2012, 215(6): 810-819.
14. Zureikat AH, Moser AJ, Boone BA, et al. 250 robotic pancreatic resections: safety and feasibility. Ann Surg, 2013, 258(4): 554-562.
15. Kim SC, Song KB, Jung YS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc, 2013, 27(1): 95-103.
16. Chalikonda S, Aguilar-Saavedra JR, Walsh RM. Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc, 2012, 26(9): 2397-2402.
17. Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Surg Endosc, 2006, 20(7): 1045-1050.
18. Pugliese R, Scandroglio I, Sansonna F, et al. Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech, 2008, 18(1): 13-18.
19. Bencini L, Annecchiarico M, Farsi M, et al. Minimally invasive surgical approach to pancreatic malignancies. World J Gastrointest Oncol, 2015, 7(12): 411-421.
20. 中华医学会外科学分会胰腺外科学组, 中国医疗保健国际交流促进会胰腺病分会胰腺微创治疗学组, 中国研究型医院学会胰腺疾病专业委员会胰腺微创学组, 等. 腹腔镜胰十二指肠切除手术专家共识(附: 手术流程与主要步骤). 中华外科杂志, 2017, 55(5): 335-339.
21. Jacobs MJ, Kamyab A. Total laparoscopic pancreaticoduodenectomy. JSLS, 2013, 17(2): 188-193.
22. 鲁超, 金巍巍, 牟一平, 等. 腹腔镜胰十二指肠切除术的学习曲线. 外科理论与实践, 2015, 20(6): 485-489.
23. 林浩铭, 李国林, 常瑞明, 等. 动脉入路腹腔镜胰十二指肠切除 19 例报道. 中国普外基础与临床杂志, 2014, 21(10): 1237-1240.
24. 孙跃明, 苗毅. 腹腔镜胰十二指肠切除术应用及其评价. 中国实用外科杂志, 2010, 30(3): 190-192.
25. 洪德飞, 张宇华, 张成武, 等. 腔镜胰十二指肠切除术在壶腹周围癌中的应用. 中国普外基础与临床杂志, 2016, 23(4): 393-397.
26. 张华, 王明俊, 王昕, 等. 腹腔镜胰十二指肠切除术 45 例体会. 中国普外基础与临床杂志, 2014, 21(8): 940-945.
27. 李敬东, 李勇, 冷政伟, 等. 缩短腹腔镜胰十二指肠切除术学习曲线的经验. 中国普外基础与临床杂志, 2016, 23(4): 398-402.
28. 金巍巍, 徐晓武, 牟一平, 等. 腹腔镜胰十二指肠切除术 66 例初步经验总结. 中华外科杂志, 2016, 54(2): 84-88.
29. 金巍巍, 徐晓武, 牟一平, 等. 腹腔镜胰十二指肠切除术单中心 233 例临床经验总结. 中华外科杂志, 2017, 55(5): 354-358.
30. Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preliminary experience of “counter clockwise resection” in total laparoscopic pan-creaticoduodenectomy

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