Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center.
BACKGROUND
Laparoscopic pancreaticoduodenectomy is a technically demanding surgery performed only at few centers in the world. This article aims to describe the evolution of the technique and summarizes the results in our institute over the years.


METHODS
Prospective data of patients undergoing laparoscopic pancreaticoduodenectomy from March 1998 to January 2009 was retrospectively reviewed.


RESULTS
There were a total of 75 patients (22 females and 53 males) with a mean age of 62 (range, 28-76) years. Conversion rate was 0%, overall postoperative morbidity was 26.7% and mortality rate was 1. 33%. Pancreatic fistula was seen in 6.67%. The mean operating time was 357 min (range 270-650), and the mean blood loss was 74 ml (range 35-410). The average time to the first bowel movement was 3 days and mean hospital stay was 8.2 days (range 6-42). Resected margins were positive in 2.6% of cases. The mean number of retrieved lymph nodes for the malignant lesions was 14 (range 8-22).


CONCLUSIONS
Laparoscopic pancreaticoduodenectomy can be safely performed by highly skilled laparoscopic surgeons. This technique can achieve adequate margins and follow oncological principles. Randomized comparative trials are needed to establish the superiority of laparoscopy versus open surgery.
Palanivelu
C
C
GEM Hospital, 45-A, Pankaja Mill Road, Ramnathapuram, Coimbatore, 641045, India. cp@gemhospital.net
Rajan
P S
PS
Rangarajan
M
M
Vaithiswaran
V
V
Senthilnathan
P
P
Parthasarathi
R
R
Praveen Raj
P
P
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D016063:Blood Loss, Surgical; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007583:Jejunum / Q000601:surgery; D010535:Laparoscopy / Q000379:methods / Q000401:mortality / Q000639:trends*; D008137:Longitudinal Studies; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors