Totally laparoscopic pancreaticoduodenectomy with tangential portal vein resection

Abstract

Totally laparoscopic pancreaticoduodenectomy (TLP) is an oncologically safe and feasible technique. It is performed in centers experienced in laparoscopic hepatobiliary surgery. Locally advanced pancreatic cancer with portal venous invasion seems to be a relative contraindication for laparoscopic surgery. There is no definitive data supporting such an approach. Case of a 47-year-old male patient with locally advanced pancreatic cancer determined to have portal confluence invasion in the preoperative period is reported in this study. Tumor was successfully resected with laparoscopic tangential portal vein resection (TPVR). In a selected patient with locally advanced pancreatic cancer, TLP with TPVR appears to be a safe and viable procedure when performed in high-volume centers with experience in laparoscopic hepatobiliary surgery.

Laparoscopic pancreatic resection—a review

“…Of note, however, margin status may not be the ideal parameter for comparisons because definitions of margin involvement vary and underreporting of microscopic margin involvement has been described (51). Portal venous infiltration as such is not a contraindication for the LPD (52). Interestingly, Croome and colleagues (45) reported a significantly longer interval of progression free survival and a shorter median time to adjuvant chemotherapy in LPD.…”

Pushing the Limits of Laparoscopic Surgery

“…9 It is now obvious that bleeding can be controlled quite adequately by skilled surgeons, laparoscopically, without harm to the patient, without the need to convert. Apparently startling to think about a few years ago, experienced surgeons can take care of bleeding from major vessels, even the portal vein during pancreatic head resections, 10 once again, without having to convert, because it is possible to compress the vessel, suture or repair it with precision (magnification) without any more loss of blood than most surgeons would have in open surgery. Moreover, raising the intraabdominal pressure for the minimal time necessary for hemostasis is a most useful adjunct.…”