International expert consensus on laparoscopic pancreaticoduodenectomy*

Abstract

Importance: While laparoscopic pancreaticoduodenectomy (LPD) is being adopted with increasing enthusiasm worldwide, it is still challenging for both technical and anatomical reasons. Currently, there is no consensus on the technical standards for LPD.Objective: The aim of this consensus statement is to guide the continued safe progression and adoption of LPD.Evidence Review: An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreaticoduodenectomy. Statements were produced upon reviewing the literature and assessed by the members of the expert panel. The literature search and its critical appraisal were limited to articles published in English during the period from 1994 to 2019. The Web of Science, Medline, and Cochrane Library and Clinical Trials databases were searched, The search strategy included, but was not limited to, the terms 'laparoscopic', 'pancreaticoduodenectomy, 'pancreatoduodenectomy', 'Whipple's operation', and 'minimally invasive surgery'. Reference lists from the included articles were manually checked for any additional studies, which were included when appropriate. Delphi method was used to establish expert consensus and the AGREE II-GRS Instrument was applied to assess the methodological quality and externally validate the final statements. The statements were further discussed during a one-day face-to-face meeting at the 1 st Summit on Minimally Invasive Pancreatico-Biliary Surgery in Wuhan, China.Findings: Twenty-eight international experts from 8 countries constructed the expert panel. Sixteen statements were produced by the members of the expert panel. At least 80% of responders agreed with the majority (80%) of statements. Other than three randomized controlled trials published to date, most evidences were based on level 3 or 4 studies according to the AGREE II-GRS Instrument. Conclusions and Relevance:The Wuhan international expert consensus meeting on LPD has produced a set of clinical practice statements for the safe development and progression of LPD. LPD is currently in its development and exploration stages, as defined by the international IDEAL framework for surgical innovation. More robust randomized controlled trial and registry study are essential to proceed with the assessment of LPD.

Comparison of postoperative complications and long‐term oncological outcomes in minimally invasive versus open pancreatoduodenectomy for distal cholangiocarcinoma: A propensity score‐matched analysis

“…The surgeons who performed MIPD meet the requirements by international expert consensus on laparoscopic pancreatoduodenectomy 16 (high‐volume center and experience of >200 OPD cases before starting MIPD). The patients who had the possibility of undergoing “standard PD” as recommended by the International Study Group on Pancreatic Surgery (ISGPS) underwent MIPD 17 .…”

Intraoperative navigation system with a multi-modality fusion of 3D virtual model and laparoscopic real-time images in laparoscopic pancreatic surgery: a preclinical study

“…However, a surgeon needs to take a lot of time and effort to achieve the proficiency in laparoscopic pancreatic surgery [ 24 , 25 ]. Dissection of the main blood vessels is a key step for pancreatic surgery [ 26 ]. In the current study, we tried to use advanced technology to provide an effective method to accurately locate the main blood vessels to shorten the operation time, reduce the degree of technical difficulty and accelerate the learning curve of laparoscopic pancreatic surgery.…”

Surgical Treatment of Pancreatic Ductal Adenocarcinoma

“…An international consensus statement on robotic pancreatic surgery showed that robotic pancreatic surgery is safe and feasible compared to open pancreatic surgery [ 89 ]. Another international expert consensus on laparoscopic pancreaticoduodenectomy (PD) also showed that laparoscopic pancreaticoduodenectomy was safe and effective for experienced surgeons [ 90 ]. Furthermore, a current network meta-analysis indicated that laparoscopic PD and robotic PD had a reduced length of hospital stay, operative bleeding and overall complications while on the other hand achieving a similar number of retrieved lymph nodes, tumor-free resection margins, clinically relevant postoperative pancreatic fistula, severe postoperative complications [ 91 ].…”