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. 2015 Sep;10(3):450-7.
doi: 10.5114/wiitm.2015.54040. Epub 2015 Sep 11.

Pure laparoscopic pancreatoduodenectomy with initial approach to the superior mesenteric artery

Juan Santiago Azagra  1 , Luca Arru  1 , Sergio Estévez  1 , Makkai-Popa Silviu-Tiberiu  1 , Virginie Poulain  1 , Martine Goergen  1
Affiliations

Pure laparoscopic pancreatoduodenectomy with initial approach to the superior mesenteric artery

Juan Santiago Azagra et al. Wideochir Inne Tech Maloinwazyjne. 2015 Sep.

Abstract

Introduction: The "artery-first approach" (AFA) to the superior mesenteric artery allows an early assessment of resectability of pancreatic tumours and could improve the benefits of laparoscopy, reducing invasiveness, especially for unresectable tumours.

Aim: To describe our technique of pure laparoscopic pancreatoduodenectomy (PLPD) with the AFA, and to report the surgical outcomes of this procedure in a small series of 12 patients through a retrospective analysis of a prospectively collected database.

Material and methods: Twelve selected patients underwent elective full laparoscopic pancreatoduodenectomy with the AFA. The technical aspects of the procedure are described in detail and the included images facilitate the understanding of the procedure.

Results: The mean operative time was 300 min (range: 250-540 min). No intraoperative complications were observed. No conversion to laparotomy was necessary. The mean postoperative hospital stay was 18 days (range: 8-42). Mortality was null. There were 3 major complications at the 3rd post-operative month follow-up: 2 patients reporting a grade A pancreatic fistula and one biliary fistula.

Conclusions: Our work shows that pure laparoscopic pancreatoduodenectomy (PLPD) with the AFA is feasible, in selected patients. The AFA could improve on the advantages of laparoscopy in the identification of unresectable patients, and it also allows early control of vascular structures.

Keywords: artery first approach; feasibility; laparoscopy; pancreatoduodenectomy; pure laparoscopy; short-term outcomes.

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Figures

Figure 1
Figure 1
Operative team and trocar placement according to the operative stage. A – Kocher manoeuvre and AFA. B – Vascular dissection and pancreatic transaction. C – Treitz and uncinate process dissection. D – Biliary section and reconstruction. S1 – first surgeon; S2, S3 – assistants. The black dots represent the trocars used by the first surgeon for each stage of the procedure
Photo 1
Photo 1
Resection stages of the procedure – explained in text
Photo 2
Photo 2
Reconstruction stages of the procedure – explained in text
See this image and copyright information in PMC

References

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