Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2016; 8(12): 784-791
Published online Dec 27, 2016. doi: 10.4240/wjgs.v8.i12.784
Contemporary review of minimally invasive pancreaticoduodenectomy
Rui Dai, Ryan S Turley, Dan G Blazer
Rui Dai, Ryan S Turley, Dan G Blazer, Department of Surgery, Advanced Oncologic and GI Surgery Division, Duke University Medical Center, Durham, NC 27708, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: Dai R, Turley RS and Blazer DG declare no conflict of interests. No financial support.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Duke University Medical Center, who will provide a permanent, citable and open-access home for the dataset.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dan G Blazer, MD, FACS, Associate Professor of Surgery, Department of Surgery, Advanced Oncologic and GI Surgery Division, Duke University Medical Center, Box 3247, Durham, NC 27708, United States.
Telephone: +1-919-6846553
Received: June 26, 2016
Peer-review started: June 28, 2016
First decision: August 5, 2016
Revised: September 9, 2016
Accepted: October 5, 2016
Article in press: October 9, 2016
Published online: December 27, 2016

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.

Keywords: Pancreatic adenocarcinoma, Periampullary malignancy, Pancreaticoduodenectomy, Minimally invasive surgery, Whipple

Core tip: In this contemporary review, we systematically review current literature regarding minimally invasive techniques and outcomes for pancreaticoduodenectomy. This review will be highly educational to providers-surgical and nonsurgical alike-who care for patients with resectable periampullary malignancies.