title: Total laparoscopic pancreaticoduodenectomy and reconstruction for a cholangiocarcinoma of the bile duct.
abstract: BACKGROUND
  In this paper, we report on our experience with a totally laparoscopic pancreatico-duodenectomy performed for a cholangiocarcinoma of the lower third of the bile duct.
  
  
  METHODS
  The patient was placed in the steep reverse Trendelenberg, Lloyd-Davis position. The procedure was performed with six laparoscopic ports, using similar steps to the open approach, with the use of an ultrasonic cutting and coagulating instrument for dissection and endoscopic linear stapling devices for the bile duct, intestinal, and gastroduodenal artery division. Reconstruction was done on a single loop by an intracorporeally sutured pancreaticojejunostomy, hepaticojejunostomy, and a stapled gastroenterostomy. The resection specimen was placed in a bag and retrieved through a 5-cm Pfannenstiel incision.
  
  
  RESULTS
  Histology confirmed a T3 N1 R0 cholangiocarcinoma with the involvement of 1 of 17 lymph nodes. Twelve months following surgery, he remains well, having completed a course of adjuvant chemotherapy.
  
  
  CONCLUSIONS
  Although the operation was technically demanding, it can be safely performed with a good oncologic result.
authors.affiliation: Department of Hepatopancreaticobiliary and Transplant Surgery, St. James's University Hospital, Leeds, United Kingdom. kvmenon@aol.com
authors.forename: Krishna V
authors.initials: KV
authors.lastname: Menon
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Hayden
authors.forename: K Rajendra
authors.initials: KR
authors.lastname: Prasad
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Verbeke
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D016577:Pancreaticoduodenectomy; D019651:Plastic Surgery Procedures / Q000379:methods*