How to Perform Total Laparoscopic Duodenum-Preserving Pancreatic Head Resection Safely and Efficiently with Innovative Techniques

Laparoscopic duodenum–preserving pancreatic head resection with real-time indocyanine green guidance of different dosage and timing: enhanced safety with visualized biliary duct and its long-term metabolic morbidity

“…DPPHR was initially introduced for chronic pancreatitis by Beger [6] and was proven to decrease the long-term endocrine and exocrine dysfunction compared with pancreaticoduodenectomy (PD) [2,3]. However, in terms of laparoscopic DPPHR, our team reported the first case in 2016 [7]; later on, a few studies reported 12-24 cases are complicated with astonishing biliary leakages of 4.5-16.7% without exception [8][9][10]. Moreover, none of them reported the long-term metabolic dysfunction, which was of great importance on deciding whether to perform L-DPPHR or not.…”

“…Similarly, Cai et al reported elevated POPF in 45.8% of the L-DPPHR patients with only 4.2% Grade B POPF [ 9 ]. Others observed an overall complication of 20–36.4% with 6.7–16.7% POPF after L-DPPHR [ 8 , 10 , 13 , 20 ]. As high as the POPF rate was, only 8% (2) of the patients required intervention, including one required reoperation and the other one controlled by DSA.…”

“…Duodenum-preserving pancreatic head resection (DPPHR) was first introduced by Beger in 1972 [6]. Attempts to perform Laparoscopic DPPHR(L-DPPHR) was made amidst the soaring passion for laparoscopic pancreatic surgery [7][8][9][10][11][12][13]. However, limited studies indicated alarming biliary leaks which varied from 11.8 to 16.7% [8][9][10][11][12][13], greatly restricting its applications because of the fear of injuring the invisible bile ducts embedded in the pancreas.…”

“…Attempts to perform Laparoscopic DPPHR(L-DPPHR) was made amidst the soaring passion for laparoscopic pancreatic surgery [7][8][9][10][11][12][13]. However, limited studies indicated alarming biliary leaks which varied from 11.8 to 16.7% [8][9][10][11][12][13], greatly restricting its applications because of the fear of injuring the invisible bile ducts embedded in the pancreas. In 2009, Ishizawa introduced the usage of indocyanine green (ICG) fluorescence imaging to delineate the bile duct intra-operatively, and it enabled realtime identification of biliary anatomy to avoid biliary injury [14].…”

Preoperative 3D reconstruction and fluorescent indocyanine green for laparoscopic duodenum preserving pancreatic head resection: A case report

“…Combined with fluorescence technology and preoperative 3D model reconstruction, the LDPPHR under fluorescence navigation is beneficial. The fluorescence dye, indocyanine green (ICG) used intravenously during surgery is excreted through the bile, showing green fluorescence under near-infrared light excitation[ 6 ]. The use of fluorescence navigation technology greatly improves the visualization of biliary anatomy for accurate planning and resection and prevents intraoperative bile duct injury.…”