• Humans
• Pancreaticoduodenectomy/methods
• Pancreaticoduodenectomy/standards
• Patient Selection
• Laparoscopy
• Robotic Surgical Procedures
• Consensus
• Clinical Competence
• Minimally Invasive Surgical Procedures
• Risk Factors
• Pancreatic Diseases/surgery

• Minimally invasive pancreatectomy
• Reduced-port robotic surgery
• Robotic pancreaticoduodenectomy
• Robotic surgical procedures
• Single-port pancreatoduodenectomy

• Pancreaticoduodenectomy/methods
• Humans
• Robotic Surgical Procedures/methods
• Male
• Female
• Middle Aged
• Aged
• Operative Time
• Pancreatic Neoplasms/surgery
• Adult
• Length of Stay/statistics & numerical data
• Retrospective Studies
• Laparoscopy/methods
• Aged, 80 and over
• Treatment Outcome

Pancreatic surgery has been one of the last areas for the application of minimally invasive surgery (MIS) because there are many factors that make laparoscopic pancreas resections difficult. The concept of service centralization has also limited expertise to a small cadre of high-volume centres in resource rich countries. However, this is not the environment that many surgeons in developing countries work in. These patients often do not have the opportunity to travel to high volume centres for care. Therefore, we sought to review the existing data on MIS for the pancreas and to discuss. In this paper, we review the evolution of MIS on the pancreas and discuss the incorporation of this service into low-volume and resource-poor countries, such as those in the Caribbean. This paper has two parts. First, we performed a literature review evaluating all studies published on laparoscopic and robotic surgery of the pancreas. The data in the Caribbean is examined and we discuss tips for incorporating this operation into resource poor hospital practice. Low pancreatic case volume in the Caribbean, and financial barriers to MIS in general, laparoscopic distal pancreatectomy, enucleation and cystogastrostomy are feasible operations to integrate in to a resource-limited healthcare environment. This is because they can be performed with minimal to no consumables and require an intermediate MIS skillset to complement an open pancreatic surgeon’s peri-operative experience.

• Pancreas
• Surgery
• Laparoscopic
• Minimally invasive
• Pancreatectomy
• Whipple’s
• Pancreaticoduidenectomy

• body mass index
• pancreaticoduodenectomy
• perioperative outcomes

• Consensus
• Delphi technique
• laparoscopy
• pancreaticoduodenectomy

• Female
• Humans
• Laparoscopy
• Length of Stay
• Male
• Middle Aged
• Operative Time
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy
• Postoperative Complications/epidemiology
• Propensity Score
• Retrospective Studies
• Survival Rate
• Treatment Outcome

• Pancreatic stump management
• Postoperative pancreatic fistula
• Robot-assisted pancreaticoduodenectomy

• Laparoscopic
• learning curve
• pancreaticoduodenectomy
• robotic

Laparoscopic pancreaticoduodenectomy (LPD), a surgical option for nonpancreatic periampullary adenocarcinoma (NPPA), is a complex procedure that has become increasing popular. However, there is no consensus as to whether this technique should be performed routinely. Our aim was to evaluate the outcomes of LPD compared with open pancreaticoduodenectomy (OPD).

From October 2010 to September 2015, 58 LPDs were performed to treat NPPA and were compared with 58 OPDs, which can theoretically be carried out by laparoscopic approach. Patients were also matched based on their demographic data and pathologic diagnosis. Demographic information, intraoperative and postoperative data, pathologic data, and follow-up evaluation data were collected at our center.

All patients had a median follow-up of 34 months (range, 8 to 60 mo). Overall median survival during the study between the groups was not different (P=0.760). No significant differences between the 2 groups were found in terms of patient demographics, short-term complications, pathologic outcomes, or tumor-node-metastasis stage. With regard to operative time, the LPD group was slightly longer than the OPD group (P<0.001). There were significant differences between groups in the time to the first passage of flatus and the time to oral intake (P<0.001). However, no differences were seen in blood loss, length of intensive care unit stay, node positive, or R0 resection between the laparoscopic and open groups.

This study found that LPD is a feasible, safe, and effective method for the treatment of NPPA compared with OPD and may be a preferred method for surgeons to choose.

• Laparoscopy
• Meta-analysis
• Minimally invasive
• Morbidity
• Pancreaticoduodenectomy
• Review
• Robot

• Distal pancreatectomy
• Laparoscopy
• Pancreatectomy
• Pancreatic enucleation
• Pancreaticoduodenectomy
• Review

• Humans
• Laparoscopy/methods
• Pancreatectomy/methods
• Pancreatectomy/trends
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy/methods
• Pancreaticoduodenectomy/trends

• Guidelines
• Laparoscopic pancreatectomy
• Minimally invasive pancreatoduodenectomy
• Pancreatic cancer
• Robotic pancreatectomy

• Adenocarcinoma/mortality
• Adenocarcinoma/surgery
• Humans
• Laparoscopy/methods
• Laparoscopy/trends
• Minimally Invasive Surgical Procedures/methods
• Minimally Invasive Surgical Procedures/trends
• Neoplasm Grading
• Organ Sparing Treatments/adverse effects
• Organ Sparing Treatments/trends
• Pancreas/pathology
• Pancreas/surgery
• Pancreatectomy/methods
• Pancreatectomy/trends
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy/methods
• Pancreaticoduodenectomy/trends
• Quality of Life
• Robotic Surgical Procedures/methods
• Robotic Surgical Procedures/trends
• Spleen/surgery
• Survival Rate
• Treatment Outcome

• Long term survival
• Low volume hospitals
• Minimally invasive surgical procedures
• Oncologic treatment
• Pancreatic surgery

To assess the current literature describing various minimally invasive techniques for and to review short-term outcomes after minimally invasive pancreaticoduodenectomy (PD).

PD remains the only potentially curative treatment for periampullary malignancies, including, most commonly, pancreatic adenocarcinoma. Minimally invasive approaches to this complex operation have begun to be increasingly reported in the literature and are purported by some to reduce the historically high morbidity of PD associated with the open technique. In this systematic review, we have searched the literature for high-quality publications describing minimally invasive techniques for PD-including laparoscopic, robotic, and laparoscopic-assisted robotic approaches (hybrid approach). We have identified publications with the largest operative experiences from well-known centers of excellence for this complex procedure. We report primarily short term operative and perioperative results and some short term oncologic endpoints.

Minimally invasive techniques include laparoscopic, robotic and hybrid approaches and each of these techniques has strong advocates. Consistently, across all minimally invasive modalities, these techniques are associated less intraoperative blood loss than traditional open PD (OPD), but in exchange for longer operating times. These techniques are relatively equivalent in terms of perioperative morbidity and short term oncologic outcomes. Importantly, pancreatic fistula rate appears to be comparable in most minimally invasive series compared to open technique. Impact of minimally invasive technique on length of stay is mixed compared to some traditional open series. A few series have suggested that initiation of and time to adjuvant therapy may be improved with minimally invasive techniques, however this assertion remains controversial. In terms of short-terms costs, minimally invasive PD is significantly higher than that of OPD.

Minimally invasive approaches to PD show great promise as a strategy to improve short-term outcomes in patients undergoing PD, but the best results remain isolated to high-volume centers of excellence.

• Pancreatic adenocarcinoma
• Periampullary malignancy
• Pancreaticoduodenectomy
• Minimally invasive surgery
• Whipple

• Da Vinci
• Minimally invasive surgery
• Pancreaticoduodenectomy
• Total pancreatectomy

• laparoscopic central pancreatectomy
• laparoscopic distal pancreatectomy
• laparoscopic pancreaticoduodenectomy
• laparoscopic total pancreatectomy
• postoperative pancreatic fistula

• Disease-Free Survival
• Female
• Humans
• Laparoscopy/methods
• Laparoscopy/mortality
• Length of Stay
• Male
• Operative Time
• Pancreatectomy/methods
• Pancreatectomy/mortality
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy/methods
• Pancreaticoduodenectomy/mortality
• Postoperative Complications/mortality
• Postoperative Complications/physiopathology
• Prognosis
• Risk Assessment
• Survival Analysis
• Treatment Outcome

• Laparoscopy
• Learning curve
• Minimally invasive surgery
• Pancreaticoduodenectomy
• Robot

Pancreatic duct adenocarcinoma is one of the most fatal malignancies, with R0 resection remaining the most important part of treatment of this malignancy. However, pancreatectomy is believed to be one of the most challenging procedures and R0 resection remains the only chance for patients with pancreatic cancer to have a good prognosis. Some surgeons have tried minimally invasive pancreatic surgery, but the short- and long-term outcomes of pancreatic malignancy remain controversial between open and minimally invasive procedures. We collected comparative data about minimally invasive and open pancreatic surgery. The available evidence suggests that minimally invasive pancreaticoduodenectomy (MIPD) is as safe and feasible as open PD (OPD), and shows some benefit, such as less intraoperative blood loss and shorter postoperative hospital stay. Despite the limited evidence for MIPD in pancreatic cancer, most of the available data show that the short-term oncological adequacy is similar between MIPD and OPD. Some surgical techniques, including superior mesenteric artery-first approach and laparoscopic pancreatoduodenectomy with major vein resection, are believed to improve the rate of R0 resection. Laparoscopic distal pancreatectomy is less technically demanding and is accepted in more pancreatic centers. It is technically safe and feasible and has similar short-term oncological prognosis compared with open distal pancreatectomy.

• Laparoscopic
• Minimally invasive
• Robotic
• Pancreaticoduodenectomy
• Distal pancreatectomy
• Pancreatic cancer

• Carcinoma, Pancreatic Ductal/surgery
• Humans
• Laparoscopy/methods
• Minimally Invasive Surgical Procedures/methods
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy/methods
• Prognosis
• Robotic Surgical Procedures/methods
• Treatment Outcome

• Humans
• Conversion to Open Surgery
• Feasibility Studies
• Laparoscopy/methods
• Minimally Invasive Surgical Procedures/methods
• Pancreatic Diseases/surgery
• Pancreaticoduodenectomy/methods
• Robotics

• complications
• elderly patients
• total laparoscopic pylorus-preserving pancreatoduodenectomy

• distal pancreatectomy
• pancreatic surgery
• robotic surgery
• whipple's procedure

AIM: To investigate the advantages of inferoposterior duodenal approach (IPDA) for laparoscopic pancreaticoduodenectomy (LPD).

METHODS: A total of 36 patients subjected to LPD were admitted to the Affiliated Yijishan Hospital of Wannan Medical College from December 2009 to February 2015. These patients were diagnosed with an ampullary tumour or a pancreatic head tumour through computed tomography, magnetic resonance imaging or endoscopic retrograde cholangiopancreatography preoperatively. The cases were selected on the basis of the following criteria: tumour diameter < 4 cm; no signs of peripheral vascular invasion; evident lymph node swelling; and distant metastasis. Of the 36 cases, 20 were subjected to anterior approach (AA; AA group) and 16 were subjected to IPDA (IPDA group). Specimen removal time, intraoperative blood loss and postoperative complications in the two groups were observed, and their differences were compared.

RESULTS: During the operation, 2 cases in the AA group and 2 cases in the IPDA group were converted to laparotomy; these cases were excluded from statistical analysis. The remaining 32 cases successfully completed the surgery. The AA group and IPDA group exhibited the specimen removal time of 205 ± 52 and 160 ± 35 min, respectively, and the difference was significant (P < 0.01). The AA group and IPDA group revealed the intraoperative blood loss of 360 ± 210 mL and 310 ± 180 mL, respectively, but these values were not significantly different. Postoperative pathological results revealed 4 cases of inferior common bile duct cancer, 8 cases of duodenal papillary cancer, 6 cases of ampullary cancer, 13 cases of pancreatic cancer, 3 cases of chronic pancreatitis accompanied with cyst formation or duct expansion, and 2 cases of mucinous cystic tumour in the pancreatic head. The postoperative complications were pulmonary Staphylococcus aureus infection, incision faulty union, ascites induced poor drainage accompanied with infection, bile leakage, pancreatic leakage and delayed abdominal bleeding.

CONCLUSION: In IPDA, probing for important steps can be performed in early stages, surgical procedures can be optimised and operation time can be shortened.

• Laparoscopic pancreaticoduodenectomy
• Surgical approach

• Adult
• Aged
• Ampulla of Vater/diagnostic imaging
• Ampulla of Vater/pathology
• Ampulla of Vater/surgery
• Blood Loss, Surgical
• China
• Common Bile Duct Neoplasms/diagnostic imaging
• Common Bile Duct Neoplasms/pathology
• Common Bile Duct Neoplasms/surgery
• Duodenum/diagnostic imaging
• Duodenum/surgery
• Female
• Humans
• Laparoscopy/adverse effects
• Male
• Middle Aged
• Operative Time
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy/adverse effects
• Pancreaticoduodenectomy/methods
• Postoperative Complications/etiology
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome

• Laparoscopic pancreaticoduodenectomy
• Laparoscopy-assisted pancreaticoduodenectomy
• Pancreaticoduodenectomy

• Whipple
• innovation
• minimally invasive surgery (MIS)
• operative technique
• pancreatic adenocarcinoma

• Laparoscopic
• laparoscopic vs. open
• laparoscopy
• pancreaticoduodenectomy
• review
• whipple

• laparoscopy
• minimally invasive surgery
• pancreatectomy
• pancreatic surgery
• robot-assisted surgery
• robotic surgery

• Laparoscopic pancreaticoduodenectomy/Whipple procedure
• Oncologic outcomes
• Technical safety

AIM: To compare laparoscopic pancreaticoduodenectomy (TLPD) during the initial learning curve with open pancreaticoduodenectomy in terms of outcome and costs.

METHODS: This is a retrospective review of the consecutive patients who underwent TLPD between December 2009 and April 2014 at our institution. The experiences of the initial 15 consecutive TLPD cases, considered as the initial learning curve of each surgeon, were compared with the same number of consecutive laparotomy cases with the same spectrum of diseases in terms of outcome and costs. Laparoscopic patients with conversion to open surgery were excluded. Preoperative demographic and comorbidity data were obtained. Postoperative data on intestinal movement, pain score, mortality, complications, and costs were obtained for analysis. Complications related to surgery included pneumonia, intra-abdominal abscess, postpancreatectomy hemorrhage, biliary leak, pancreatic fistula, delayed gastric emptying, and multiple organ dysfunction syndrome. The total costs consisted of cost of surgery, anesthesia, and admission examination.

RESULTS: A total of 60 patients, including 30 consecutive laparoscopic cases and 30 consecutive open cases, were enrolled for review. Demographic and comorbidity characteristics of the two groups were similar. TLPD required a significantly longer operative time (513.17 ± 56.13 min vs 371.67 ± 85.53 min, P < 0.001). The TLPD group had significantly fewer mean numbers of days until bowel sounds returned (2.03 ± 0.55 d vs 3.83 ± 0.59 d, P < 0.001) and exhaustion (4.17 ± 0.75 d vs 5.37 ± 0.81 d, P < 0.001). The mean visual analogue score on postoperative day 4 was less in the TLPD group (3.5 ± 9.7 vs 4.47 ± 1.11, P < 0.05). No differences in surgery-related morbidities and mortality were observed between the two groups. Patients in the TLPD group recovered more quickly and required a shorter hospital stay after surgery (9.97 ± 3.74 d vs 11.87 ± 4.72 d, P < 0.05). A significant difference in the total cost was found between the two groups (TLPD 81317.43 ± 2027.60 RMB vs laparotomy 78433.23 ± 5788.12 RMB, P < 0.05). TLPD had a statistically higher cost for both surgery (24732.13 ± 929.28 RMB vs 19317.53 ± 795.94 RMB, P < 0.001) and anesthesia (6192.37 ± 272.77 RMB vs 5184.10 ± 146.93 RMB, P < 0.001), but a reduced cost for admission examination (50392.93 ± 1761.22 RMB vs 53931.60 ± 5556.94 RMB, P < 0.05).

CONCLUSION: TLPD is safe when performed by experienced pancreatobiliary surgeons during the initial learning curve, but has a higher cost than open pancreaticoduodenectomy.

• Cost
• Initial learning curve
• Laparoscopic surgery
• Pancreaticoduodenectomy
• Postoperative event

• Adult
• Aged
• Clinical Competence/economics
• Cost-Benefit Analysis
• Female
• Hospital Costs
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/economics
• Laparotomy/adverse effects
• Laparotomy/economics
• Learning Curve
• Length of Stay/economics
• Male
• Middle Aged
• Operative Time
• Pancreaticoduodenectomy/adverse effects
• Pancreaticoduodenectomy/economics
• Pancreaticoduodenectomy/methods
• Postoperative Complications/economics
• Time Factors
• Treatment Outcome

• Laparoscopic pancreaticoduodenectomy
• Oncology
• Survival

• Adenocarcinoma/surgery
• Adult
• Aged
• Aged, 80 and over
• Duodenal Neoplasms/surgery
• Feasibility Studies
• Female
• Follow-Up Studies
• Humans
• Laparoscopy/methods
• Male
• Middle Aged
• Operative Time
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy/methods
• Pancreatitis, Chronic/surgery
• Prospective Studies
• Treatment Outcome

AIM: To evaluate the feasibility, safety, and efficacy of laparoscopic pancreaticoduodenectomy (LPD) using a reverse-“V” approach with four ports.

METHODS: This is a retrospective study of selected patients who underwent LPD at our center between April 2011 and April 2012. The following data were collected and reviewed: patient characteristics, tumor histology, surgical outcome, resection margins, morbidity, and mortality. All patients were thoroughly evaluated preoperatively by complete hematologic investigations, triple-phase helical computed tomography, upper gastrointestinal endoscopy, and biopsy of ampullary lesions (when present). Magnetic resonance cholangiopancreatography was performed for doubtful cases of lower common bile duct lesions.

RESULTS: There was no perioperative mortality. LPD was performed with tumor-free margins in all patients, including patients with pancreatic ductal adenocarcinoma (n = 6), ampullary carcinoma (n = 6), intra-ductal papillary mucinous neoplasm (n = 2), pancreatic cystadenocarcinoma (n = 2), pancreatic head adenocarcinoma (n = 3), and bile duct cancer (n = 2). The mean patient age was 65 years (range, 42-75 years). The median blood loss was 240 mL, and the mean operative time was 368 min.

CONCLUSION: LPD using a reverse-“V” approach can be performed safely and yields good results in elective patients. Our preliminary experience showed that LDP can be performed via a reverse-“V” approach. This approach can be used to treat localized malignant lesions irrespective of histopathology.

• Laparoscopic pancreaticoduodenectomy
• Operation
• Indications

• Adult
• Aged
• Bile Duct Neoplasms/pathology
• Bile Duct Neoplasms/surgery
• Blood Loss, Surgical
• China
• Diagnostic Imaging/methods
• Feasibility Studies
• Female
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Male
• Middle Aged
• Operative Time
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/surgery
• Pancreaticoduodenectomy/adverse effects
• Pancreaticoduodenectomy/methods
• Postoperative Complications/etiology
• Predictive Value of Tests
• Retrospective Studies
• Time Factors
• Treatment Outcome

• Laparoscopic
• Pancreaticoduodenectomy
• Pancreaticogastrostomy
• Pancreaticojejunostomy
• Robotic

Laparoscopic pancreaticoduodenectomy is rarely performed, and it has not been particularly successful due to its technical complexity. The objective of this study is to highlight how robotic surgery could improve a minimally invasive approach and to expose the usefulness of robotic surgery even in complex surgical procedures.

The surgical technique employed in our center to perform a pancreaticoduodenectomy, which was by means of the da Vinci™ robotic system in order to remove a duodenal gastrointestinal stromal tumor, is reported.

Robotic technology has improved significantly over the traditional laparoscopic approach, representing an evolution of minimally invasive techniques, allowing procedures to be safely performed that are still considered to be scarcely feasible or reproducible.

While more and more open procedures now routinely performed using laparoscopy, minimally invasive pancreaticoduodenectomy (MIPD) remains one of the most challenging abdominal procedures. Therefore, we carried out this meta-analysis to evaluate whether MIPD is safe, feasible and worthwhile.

PubMed, EMBASE, and Cochrane Library were searched to identify studies published between January 1994 and November 2013 comparing MIPD with open pancreaticoduodenectomy (OPD). Intraoperative outcomes, oncologic safety, postoperative complications, and postoperative recovery were evaluated.

11 retrospective studies representing 869 patients (327 MIPDs, 542 OPDs) were included. MIPD was associated with a reduction in estimated blood loss (MD −361.93 ml, 95% CI −519.22 to −204.63 ml, p<0.001, I² = 94%), wound infection (OR 0.41, 95% CI 0.22 to 0.78, p = 0.007, I² = 0%), and hospital stay (MD −2.64 d, 95% CI −4.23 to −1.05 d, p = 0.001, I² = 78%). However, it brings longer operative time (MD 105 min, 95% CI 49.73 to 160.26 min, p<0.001, I² = 93%). There were no significant differences between the two procedures in likelihood of overall complications (p = 0.05), pancreatic fistula (PF) (p = 0.86), delayed gastric empting (DGE) (p = 0.96), positive surgical margins (p = 0.07), retrieval of lymph nodes (p = 0.48), reoperation (p = 0.16) and mortality (p = 0.64).

Our results suggest that MIPD is currently safe, feasible and worthwhile. But considering the selection bias, complexity of MIPD and lack of long-term oncologic outcomes, we suggest it be performed in a high-volume pancreatic surgery center in selected patients.

• Aged
• Aged, 80 and over
• Blood Loss, Surgical
• Female
• Humans
• Lymph Node Excision
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures
• Operative Time
• Pancreaticoduodenectomy/adverse effects
• Pancreaticoduodenectomy/methods
• Pancreaticoduodenectomy/mortality
• Postoperative Complications
• Reoperation
• Retrospective Studies
• Risk Assessment
• Treatment Outcome