Laparoscopic hand-assisted pancreaticoduodenectomy: initial UK experience.
BACKGROUND
By and large, the limited world experience with laparoscopic pancreaticoduodenectomy (PD) has been unfavorable, but the laparoscopic hand-assisted approach to PD has recently shown promising results. We report the first successful UK experience with laparoscopic hand-assisted PD (LHAPD).


METHODS
A 62-year-old man who presented with painless obstructive jaundice was found at endoscopy, to have an ampullary tumor. Preoperative biopsy specimens confirmed the diagnosis of an adenocarcinoma, and CT showed no evidence of either vascular involvement or metastatic disease. A staging laparoscopy showed no intraabdominal metastases, and an LHAPD was performed using a Gelport.


RESULTS
The intraoperative course was uneventful. Two units of blood were transfused intraoperatively, but no postoperative blood transfusion was required. The operative time was 11 h (plus a 30-min break). The patients postoperative recovery was uneventful except for superficial pressure sores over the buttocks and elbows. The patient resumed oral fluid and dietary intake on the 1st and 3rd postoperative days, respectively, and was discharged from hospital on the 9th postoperative day. Histology demonstrated an ampullary adenocarcinoma with clear resection margins and involvement of two of the 13 lymph nodes examined. At 2-month follow-up, the patient remains well and is receiving adjuvant chemotherapy.


CONCLUSIONS
LHAPD achieves good oncological clearance and can be performed safely in selected patients. The early promising results with this approach will undoubtedly encourage wider adoption of this procedure and are likely to widen the selection criteria.
Ammori
B J
BJ
Department of Surgery, Hepatopancreatobiliary and Laparoscopic Unit, Manchester Royal Infirmary, Oxford Road, M13 9WL, Manchester, England, United Kingdom. Bammori@aol.com
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D001803:Blood Transfusion; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003138:Common Bile Duct Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D004739:England; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy / Q000379:methods*; D015607:Stents