Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):102-111. 10.14701/ahbps.2021.25.1.102.

Laparoscopic hybrid pancreaticoduodenectomy: Initial single center experience

• Al-Sadairi AR
• Mimmo A
• Rhaiem R
• Esposito F
• Rached LJ
• Tashkandi A
• Zimmermann P
• Memeo R
• Sommacale D
• Kianmanesh R
• Piardi T

• KMID: 2513183
• DOI: http://doi.org/10.14701/ahbps.2021.25.1.102

Abstract

Backgrounds/Aims
Pancreaticoduodenectomy (PD) is the gold standard for the treatment of periampullary tumors. Many specialized centers have adopted the totally laparoscopic or hybrid laparoscopic PD (LPD). However, this procedure has not yet been standardized and serious debate is taking place towards its safety and feasibility. Herein, we report our recent experience whit hybrid-LPD.
Methods
During 2019 in our department 56 PD were performed and 21 (37.5%) underwent hybrid-LPD. We have retrospectively reviewed the short-term outcomes of these patients.
Results
Main indication was pancreatic adenocarcinoma (71,4%). The median operative time and intraoperative blood loss were respectively 425 min (range, 226 to 576) and 317 ml (range 60 to 800 ml). Conversion to an open procedure was required in 4 patients (19%): 2 with suspected vein involvement, 1 for mesenteric panniculitis and 1 for biliary injury. The post-operative complication rate was 42.8% (9/21). Regarding post-operative pancreatic fistula, three patients (14.2%) had grade B and 1 grade C (4.7%). Median length of hospital stay was 14 days (range 9-23) and 90- days mortality was 4.7%. The mean number of harvested lymph nodes was 17.7 (range 12 to 26). The rate of margins R0 was 80%; R1 ＞0＜1 mm was 10.5% and R1 0 mm was 9.5%.
Conclusions
Hydrid–LPD is safe and feasible. Careful patient selection and increasing experience can reduce the risk of post-operative complications.

Keyword

Laparoscopic pancreaticoduodenectomy; Artery first approach; Whipple procedure; Pancreatic surgery; LN 16 dissection; Pancreatic cancer

Figure

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  Fig. 1 (A) Trocars’ position. (B) Red trocars 10 mm, green trocars 5 mm.

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  Fig. 2 Mini-laparotomy incision detail, between the xyphoid process and umbilical site.

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