title: Laparoscopic pancreatic reconstruction technique following laparoscopic pancreaticoduodenectomy.
abstract: With the advance of laparoscopic experiences and techniques, it is carefully regarded that laparoscopic pancreaticoduodenectomy (lap-PD) is feasible and safe in managing perimapullary pancreatic pathology. Especially, laparoscopic management of remnant pancreas can be a critical step toward completeness of minimally invasive PD. According to available published reports, there is a wide range of technical differences in choosing surgical options in managing remnant pancreas after lap-PD. For the evidence-based surgical approach, it would be ideal to test potential techniques by randomized controlled trials, but, currently, it is thought to be very difficult to expect those clinical trials to be successful because there are still a lack of expert surgeons with sound surgical techniques and experience. In addition, lap-PD is so complicated and technically demanding that many surgeons are still questioning whether this surgical approach could be standardized and popular like laparoscopic cholecystectomy. In general, surgical options are usually chosen based on following question: (1) Is it simple? (2) Is it easy and feasible? (3) Is it secure and safe? (4) Is there any supporting scientific evidence? It would be interesting to estimate which surgical technique would be appropriate in managing remnant pancreas under these considerations. It is hoped that a well standardized multicenter-based randomized control study would be successful to test this fundamental issues based on sound surgical techniques and scientific background.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #203, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea; Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Institute of Gastroenterology, Severance Hospital, Seoul, Korea.
authors.forename: Chang Moo
authors.initials: CM
authors.lastname: Kang
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Myung Jae
authors.initials: MJ
authors.lastname: Chung
authors.forename: Ho Kyoung
authors.initials: HK
authors.lastname: Hwang
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D010179:Pancreas / Q000601:surgery*; D010182:Pancreatic Diseases / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation
keywords: Laparoscopic; Pancreaticoduodenectomy; Pancreaticogastrostomy; Pancreaticojejunostomy; Robotic