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HOW WE DO IT
Total Laparoscopic Pancreaticoduodenectomy:

A Single-center Experience of 33 Cases in Patients with

Periampullary Tumor—Lessons Learnt

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Sameer A Rege , Ketan F Kshirsagar , Jayati J Churiwala , Shrinivas S Gond , Abdeali Saif A Kaderi 5
AbstrAct
Introduction: The introduction of minimally invasive procedures has revolutionized surgical practice worldwide. However, its application
to total pancreaticoduodenectomy since its inception in 1994 by Gagner and Pomp has elicited reluctance and skepticism due to the need
for expertise, advanced laparoscopy skills, long operative time, difficulty in adhering to oncological principles of resection, and high rates of
conversion to open surgery.
Materials and methods: A retrospective review of 33 patients who underwent total laparoscopic pancreaticoduodenectomy at a tertiary
care center in Mumbai from May 2015 to December 2019 was performed. All cases were operated by the principal investigator. Patients with
malignancy on final histopathology report were included in the study. Patients with involvement of major vessels on preoperative contrast-
enhanced computed tomography scan, distant metastasis, and contraindication to general anesthesia were excluded from the study. Perioperative
data were collected and analyzed.
Results: Thirty-three patients were operated for total laparoscopic pancreaticoduodenectomy. The average operative time was 330 minutes.
Only one patient required conversion to open surgery and postoperative blood transfusion. The resection margins were negative in all the
patients with an average lymph node retrieval rate of 12 nodes. There was no postoperative mortality.
Conclusion and clinical significance: Total laparoscopic pancreaticoduodenectomy is a safe and feasible procedure with standard laparoscopic
setup in patients with malignant periampullary disease.
Keywords: Laparoscopic pancreaticoduodenectomy, Minimally invasive pancreaticoduodenectomy, Minimal invasive surgery.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1403

IntroductIon 1–5 Department of General Surgery, Seth GS Medical College and KEM

The introduction of minimally invasive procedures has revolutionized Hospital, Mumbai, Maharashtra, India
surgical practice worldwide. However, its application to total Corresponding Author: Sameer A Rege, Department of General
pancreaticoduodenectomy since its inception in 1994 by Gagner Surgery, Seth GS Medical College and KEM Hospital, Mumbai,
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and Pomp has elicited reluctance and skepticism due to the need Maharashtra, India, Phone: +91 8369163714, e-mail: drsamrege@
for expertise, advanced laparoscopy skills, long operative time, gmail.com
difficulty in adhering to oncological principles of resection, and How to cite this article: Rege SA, Kshirsagar KF, Churiwala JJ, et al. Total
high rates of conversion to open surgery. Initially, case series were Laparoscopic Pancreaticoduodenectomy: A Single-center Experience
limited to high-volume centers with the availability of advanced of 33 Cases in Patients with Periampullary Tumor—Lessons Learnt.
laparoscopic setup. We report a series of total laparoscopic World J Lap Surg 2020;13(2):90–93.

pancreaticoduodenectomy for periampullary tumors at a tertiary Source of support: Nil
care institute in Mumbai. Conflict of interest: None
MAterIAls And Methods

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of Anaesthesiologists (ASA) classification of anesthetic risk, and
A retrospective review of 33 patients who underwent total indication for surgery. Intraoperative variables included operative
laparoscopic pancreaticoduodenectomy for periampullary time, blood loss, and transfusion requirements. Postoperative
malignancy from May 2015 to December 2019 was performed. complications were assessed during the duration of stay till
All cases were operated by the principal investigator after discharge. Pancreas-specific complications were assessed and
confirmation of periampullary tumor. Patients with malignancy graded according to the recommendations of the International
on final histopathology report were included in the study. Patients Study Group on Pancreatic Surgery. Pathological staging and
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with involvement of major vessels on preoperative contrast- margin status were determined from final histopathology reports.
enhanced computed tomography scan, distant metastasis, and
contraindication to general anesthesia were excluded from the operAtIve procedure

study. Preoperative ERCP-guided biliary stenting was performed in
patients with cholangitis and those who required optimization for Patients were operated in the split-leg supine (French) position
surgery (n = 16). Perioperative data were collected and analyzed. under general and epidural anesthesia with the operating surgeon
Preoperative variables included age, gender, American Society standing between the legs of the patient.

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