title: Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience.
abstract: OBJECTIVE
  Total laparoscopic pancreaticoduodenectomy is a safe and effective therapeutic approach.
  
  
  METHODS
  Single-institutional retrospective review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  All consecutive patients undergoing total laparoscopic pancreaticoduodenectomy from July 2007 through July 2009 at a single center (n = 62).
  
  
  METHODS
  Blood loss, operative time, postoperative morbidity, length of hospital stay, and 30-day or in-hospital mortality.
  
  
  RESULTS
  Of 65 patients undergoing laparoscopic resection, 62 patients with a mean age of 66 years (SD, 12 years) underwent total laparoscopic pancreaticoduodenectomy. The pancreaticojejunostomy consisted of a duct-to-mucosa anastomosis with interrupted suture. Median operative time was 368 minutes (range, 258-608 minutes) and median blood loss was 240 mL (range, 30-1200 mL). Diagnosis was pancreatic adenocarcinoma (n = 31), intraductal papillary mucinous neoplasm (n = 12), periampullary adenocarcinoma (n = 8), neuroendocrine tumor (n = 4), chronic pancreatitis (n = 3), cholangiocarcinoma (n = 1), metastatic renal cell carcinoma (n = 1), cystadenoma (n = 1), and duodenal adenoma (n = 1). Median tumor size was 3 cm (range, 0.9-10.0 cm) and the median number of lymph nodes harvested was 15 (range, 6-31). Perioperative morbidity occurred in 26 patients and included pancreatic fistula (n = 11), delayed gastric emptying (n = 9), bleeding (n = 5), and deep vein thrombosis (n = 2). There was 1 postoperative mortality. Median length of hospital stay was 7 days (range, 4-69 days).
  
  
  CONCLUSIONS
  Laparoscopic pancreaticoduodenectomy is feasible, safe, and effective. Outcomes appear comparable with those via the open approach; however, controlled trials are needed. Despite this series representing experience within the learning curve, laparoscopic pancreaticoduodenectomy holds promise for providing advantages seen with minimally invasive approaches in other procedures.
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. kendrick.michael@mayo.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.forename: Daniel
authors.initials: D
authors.lastname: Cusati
mesh_terms: D004066:Digestive System Diseases / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome