title: Laparoscopic pancreaticoduodenectomy via a reverse-''V'' approach with four ports: initial experience and perioperative outcomes.
abstract: OBJECTIVE
  To evaluate the feasibility, safety, and efficacy of laparoscopic pancreaticoduodenectomy (LPD) using a reverse-"V" approach with four ports.
  
  
  METHODS
  This is a retrospective study of selected patients who underwent LPD at our center between April 2011 and April 2012. The following data were collected and reviewed: patient characteristics, tumor histology, surgical outcome, resection margins, morbidity, and mortality. All patients were thoroughly evaluated preoperatively by complete hematologic investigations, triple-phase helical computed tomography, upper gastrointestinal endoscopy, and biopsy of ampullary lesions (when present). Magnetic resonance cholangiopancreatography was performed for doubtful cases of lower common bile duct lesions.
  
  
  RESULTS
  There was no perioperative mortality. LPD was performed with tumor-free margins in all patients, including patients with pancreatic ductal adenocarcinoma (n = 6), ampullary carcinoma (n = 6), intra-ductal papillary mucinous neoplasm (n = 2), pancreatic cystadenocarcinoma (n = 2), pancreatic head adenocarcinoma (n = 3), and bile duct cancer (n = 2). The mean patient age was 65 years (range, 42-75 years). The median blood loss was 240 mL, and the mean operative time was 368 min.
  
  
  CONCLUSIONS
  LPD using a reverse-"V" approach can be performed safely and yields good results in elective patients. Our preliminary experience showed that LDP can be performed via a reverse-"V" approach. This approach can be used to treat localized malignant lesions irrespective of histopathology.
authors: Zhao Liu, Department of Hepatobiliary and Pancreatic Surgery, Jinan Central Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Zhao
authors: Z
authors: Liu
authors: Zhao Liu, Department of Hepatobiliary and Pancreatic Surgery, Jinan Central Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Mu-Chuan
authors: MC
authors: Yu
authors: Zhao Liu, Department of Hepatobiliary and Pancreatic Surgery, Jinan Central Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Rui
authors: R
authors: Zhao
authors: Zhao Liu, Department of Hepatobiliary and Pancreatic Surgery, Jinan Central Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Yan-Feng
authors: YF
authors: Liu
authors: Zhao Liu, Department of Hepatobiliary and Pancreatic Surgery, Jinan Central Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Jian-Ping
authors: JP
authors: Zeng
authors: Zhao Liu, Department of Hepatobiliary and Pancreatic Surgery, Jinan Central Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Xian-Qiang
authors: XQ
authors: Wang
authors: Zhao Liu, Department of Hepatobiliary and Pancreatic Surgery, Jinan Central Hospital, Shandong University, Jinan 250012, Shandong Province, China.
authors: Jing-Wang
authors: JW
authors: Tan
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D016063:Blood Loss, Surgical; D002681:China; D003952:Diagnostic Imaging / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Indications; Laparoscopic pancreaticoduodenectomy; Operation