title: Contemporary review of minimally invasive pancreaticoduodenectomy.
abstract: OBJECTIVE
  To assess the current literature describing various minimally invasive techniques for and to review short-term outcomes after minimally invasive pancreaticoduodenectomy (PD).
  
  
  METHODS
  PD remains the only potentially curative treatment for periampullary malignancies, including, most commonly, pancreatic adenocarcinoma. Minimally invasive approaches to this complex operation have begun to be increasingly reported in the literature and are purported by some to reduce the historically high morbidity of PD associated with the open technique. In this systematic review, we have searched the literature for high-quality publications describing minimally invasive techniques for PD-including laparoscopic, robotic, and laparoscopic-assisted robotic approaches (hybrid approach). We have identified publications with the largest operative experiences from well-known centers of excellence for this complex procedure. We report primarily short term operative and perioperative results and some short term oncologic endpoints.
  
  
  RESULTS
  Minimally invasive techniques include laparoscopic, robotic and hybrid approaches and each of these techniques has strong advocates. Consistently, across all minimally invasive modalities, these techniques are associated less intraoperative blood loss than traditional open PD (OPD), but in exchange for longer operating times. These techniques are relatively equivalent in terms of perioperative morbidity and short term oncologic outcomes. Importantly, pancreatic fistula rate appears to be comparable in most minimally invasive series compared to open technique. Impact of minimally invasive technique on length of stay is mixed compared to some traditional open series. A few series have suggested that initiation of and time to adjuvant therapy may be improved with minimally invasive techniques, however this assertion remains controversial. In terms of short-terms costs, minimally invasive PD is significantly higher than that of OPD.
  
  
  CONCLUSIONS
  Minimally invasive approaches to PD show great promise as a strategy to improve short-term outcomes in patients undergoing PD, but the best results remain isolated to high-volume centers of excellence.
authors.affiliation: Rui Dai, Ryan S Turley, Dan G Blazer, Department of Surgery, Advanced Oncologic and GI Surgery Division, Duke University Medical Center, Durham, NC 27708, United States.
authors.forename: Rui
authors.initials: R
authors.lastname: Dai
authors.affiliation: Rui Dai, Ryan S Turley, Dan G Blazer, Department of Surgery, Advanced Oncologic and GI Surgery Division, Duke University Medical Center, Durham, NC 27708, United States.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Turley
authors.affiliation: Rui Dai, Ryan S Turley, Dan G Blazer, Department of Surgery, Advanced Oncologic and GI Surgery Division, Duke University Medical Center, Durham, NC 27708, United States.
authors.forename: Dan G
authors.initials: DG
authors.lastname: Blazer
keywords: Minimally invasive surgery; Pancreatic adenocarcinoma; Pancreaticoduodenectomy; Periampullary malignancy; Whipple