Pitfalls for laparoscopic pancreaticoduodenectomy: Need for a stepwise approach

Abstract

Because of today's advancements in surgical techniques and perioperative management skills, surgeons are beginning to explore the usefulness of the laparoscopic approach in managing periampullary tumors. However, as a result of its innate complexity and associated high surgery‐related complications, its applicability to the general surgical community remains controversial. To date, only retrospective data from high‐volume centers support the safety and feasibility of laparoscopic pancreaticoduodenectomy (Lap PD) for the treatment of benign conditions and malignant periampullary tumors. In addition, various surgical techniques in terms of port placement, dissection, and reconstruction have evolved in different centers depending on the preferred method commonly used by the surgeon through accumulated experience. In our center, we used a stepwise approach and standardized our surgical technique to overcome this technically demanding procedure. A collaborative implementation of video review and analysis, practice training and simulation, operating room didactics, and strict adherence to our stepwise approach in Lap PD, might potentially improve the surgical skills of young hepatobiliary surgeons and possibly overcome the volume‐based learning curve of Lap PD.

Fistula risk score‐adjusted comparison of postoperative pancreatic fistula following laparoscopic vs open pancreatoduodenectomy

“…In our experience, segmentation of the entire surgical procedure helped us to standardize the procedure. 30 Any difficulties encountered in each step could be checked and improved via collaborative video review and analysis, practice training, and simulation. Preoperative surgical simulation using a porcine model improved our surgical technique, especially in cases with a remnant soft pancreas and small pancreatic duct.…”

Adverse Impact of Intraoperative Conversion on the Postoperative Course Following Laparoscopic Pancreaticoduodenectomy

“…The surgical specimen was retrieved through a minilaparotomy wound by extending the umbilical port site where the duodenojejunostomy was performed. 5 23 24 25 …”

International expert consensus on precision anatomy for minimally invasive pancreatoduodenectomy: PAM‐HBP surgery project

“…20 These approaches were categorized according to their direction when initiating dissection around SMA. Two articles have reported the anterior approach, 30,31 posterior approach, 11,32-34 16 articles have reported the right approach, 1,4,5,14,17,24,31,[35][36][37][38][39][40][41][42][43][44] and three articles have reported the left approach, 31,45,46 indicating that many reports have described the right approach. 20 Some articles have shown the advantages of their method in comparative studies.…”