Evolution of laparoscopic pancreaticoduodenectomy at Westmead Hospital

Ji Chen, Helen Pham, Crystal Li, Christopher B. Nahm, Emma Johnston, Michael John Hollands, Tony Pang, Henry Pleass, Vincent Lam, Arthur Richardson, Lawrence Yuen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background: Despite its proposed benefits, laparoscopic pancreaticoduodenectomy (LPD) has not been widely adopted due to its technical complexity and steep learning curve. The aim of this study was to report a single surgeon's experience in the stepwise implementation of LPD and evolution of technique over a nine-year period in a moderate-high volume unit. Methods: Carefully selected patients underwent LPD initially by hybrid approach (laparoscopic resection and open reconstruction), which evolved into a total LPD (laparoscopic resection and reconstruction). Data was prospectively collected to include patient characteristics, intraoperative data, evolution of technique and postoperative outcomes. Results: A total of 25 patients underwent hybrid LPD (HLPD) and 20 patients underwent total LPD (TLPD). There was no 90-day mortality. Three patients developed a postoperative pancreatic fistula (POPF), all of which occurred in patients undergoing HLPD. There was no POPF in 20 consecutive TLPD. There was no evidence of anastomotic strictures in the hepaticojejunostomy in patients undergoing TLPD at long term follow up. Conclusion: A gradual and cautious progression from HLPD to TLPD is essential to ensure safe implementation into a unit. LPD should only be considered in carefully selected patients, with outcomes subjected to regular and rigorous independent audit.

Original languageEnglish
Pages (from-to)2648-2654
Number of pages7
JournalANZ Journal of Surgery
Volume93
Issue number11
Early online date29 Sept 2023
DOIs
Publication statusPublished - Nov 2023

Bibliographical note

Copyright the Author(s) 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • hepatopancreaticobiliary surgery
  • laparoscopic
  • pancreas
  • pancreas cancer
  • pancreaticoduodenectomy
  • surgical oncology
  • whipples

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