title: Getting Started with Minimally Invasive Pancreaticoduodenectomy: Is It Worth It?
abstract: BACKGROUND
  This study evaluates the safety and cost of introducing minimally invasive pancreaticoduodenectomy (MIPD) to a surgeon's practice.
  
  
  METHODS
  All MIPDs performed between December 2011 and July 2013 were compared with open pancreaticoduodenectomy (OPD) cases by the same surgeon. The primary outcomes were mortality, major morbidity, and re-operation. Secondary outcomes were perioperative and oncologic outcomes and cost. MIPD include total laparoscopic pancreaticoduodenectomy (TLPD) and laparoscopic-assisted pancreaticoduodenectomy (LAPD), where a small incision is used for reconstruction. Bivariate comparisons of outcomes were performed using nonparametric tests.
  
  
  RESULTS
  In total, 44 pancreaticoduodenectomies were performed: 15 MIPDs (2 TLPDs and 13 LAPDs) and 29 OPDs. One death occurred in each group. Major complication rates were not significantly different (33% for MIPD versus 17% for OPD); however, there was a trend toward more re-operation after MIPD compared with OPD (20% versus 3%; P = .07). The incidence of pancreatic leak (20% for MIPD versus 14% for OPD), biliary leak (0% versus 7%, respectively), abscess formation (27% versus 14%, respectively), and intraabdominal hemorrhage (13% versus 3%, respectively) were not significantly different. MIPD achieved equivalent oncologic outcomes as OPD with 100% R0 margin and adequate lymph node retrieval. There was no statistical difference in median operative time (342 minutes for MIPD versus 358 minutes for OPD), length of stay (8 versus 9 days, respectively), operating room expenses (Canadian) ($7246.0 versus $6912.0, respectively), or total cost (Canadian) per case ($15,034.0 versus $18,926.0, respectively).
  
  
  CONCLUSIONS
  MIPD and OPD had similar safety and cost in this introductory series. However, a trend toward a higher rate of re-operation for pancreatic leak suggests the need for caution in introducing this novel technique.
authors.affiliation: 1 Division of General Surgery, University of Toronto , Toronto, Ontario, Canada .
authors.forename: Shuyin
authors.initials: S
authors.lastname: Liang
authors.affiliation: 1 Division of General Surgery, University of Toronto , Toronto, Ontario, Canada .|2 HPB Surgery Service, St. Joseph's Health Centre , Toronto, Ontario, Canada .
authors.forename: Shiva
authors.initials: S
authors.lastname: Jayaraman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D016577:Pancreaticoduodenectomy / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies