title: [Laparoscopic pancreaticoduodenectomy: right-inferior-posterior "artery first" approach].
abstract: OBJECTIVE
  To discuss the application of right-inferior-posterior "artery first" approach in laparoscopic pancreaticoduodenectomy.
  
  
  METHODS
  Clinical data of 17 patients who underwent laparoscopic pancreaticoduodenectomy through right-inferior-posterior "artery first" approach in our department from February 2014 to April 2015 were retrospectively analyzed. The operation began at the inferior flexure of duodenum. After entering the Toldt's space, the left renal vein (LRV) was revealed and the root of superior mesenteric artery (SMA) was exposed just above the LRV. SMA was dissected along its trunk till the horizontal part of duodenum.
  
  
  RESULTS
  Of these 17 cases, adenocarcinoma of pancreatic head was observed in 5 cases, adenosquamous carcinoma in 2 cases, mucinous cycstic neoplasm in 1 case, adenocarcinoma of lower common bile duct in 4 cases, and duodenal papilla cancer in 5 cases. Fifteen cases were accomplished successfully with laparoscopy and 2 cases were converted to open approach. The average operating time was (320 ± 85) min and mean intraoperative blood loss was (305 ± 175) ml. The cutting margins were tumor negative in all the patients. The average number of harvested lymph node was 15.4 ± 6.5. Postoperative complication occurred in 5 cases. Two cases of bile leakage and 2 cases of pancreatic fistula were cured with conservative treatment. One case of delayed abdominal hemorrhage was resolved with reoperation.
  
  
  CONCLUSIONS
  Right-inferior-posterior "artery first" approach is safe and feasible in laparoscopic pancreaticoduodenectomy.
authors.affiliation: Department of Hepatobiliary Surgery, Yijishan Hospital, Wannan Medical College, An'hui Wuhu 241001, China. wxm690@aliyun.com.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Wang
authors.forename: Weidong
authors.initials: W
authors.lastname: Sun
authors.forename: Minghua
authors.initials: M
authors.lastname: Hu
authors.forename: Guannan
authors.initials: G
authors.lastname: Wang
authors.forename: Yaqi
authors.initials: Y
authors.lastname: Jiang
authors.forename: Xiaosan
authors.initials: X
authors.lastname: Fang
authors.forename: Meng
authors.initials: M
authors.lastname: Han
mesh_terms: D000230:Adenocarcinoma; D004379:Duodenal Neoplasms; D004386:Duodenum; D006801:Humans; D010535:Laparoscopy; D017538:Mesenteric Artery, Superior; D061646:Operative Time; D010179:Pancreas; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D012189:Retrospective Studies