Laparoscopic Duodenum-Preserving Pancreatic Head and Neck Resection.

Abstract

The selection of surgical approaches for benign and low-grade malignant tumors of the pancreatic head and neck, such as serous cystadenomas, neuroendocrine tumors, and intraductal papillary mucinous neoplasms (IPMNs), has long been controversial. Traditional pancreaticoduodenectomy (PD) is associated with substantial trauma and requires gastrointestinal reconstruction, which alters normal physiological structures. With a deeper understanding of pancreatic function and the advancement of minimally invasive techniques, duodenum-preserving pancreatic head resection (DPPHR) has gained increasing attention because it preserves the integrity of the duodenum and bile duct, better maintaining physiological conditions. However, this procedure imposes extremely high technical demands on surgeons, particularly when performed laparoscopically. Laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) is frequently confronted with high risks of intraoperative bleeding and postoperative pancreatic fistula (POPF). With proficiency in LDPPHR attained by the present authors and its indications extended to lesions of the pancreatic head and neck, the surgical workflow was optimized to reduce the incidence of complications. Under precise preoperative three-dimensional visualization planning and meticulous dissection guided by intraoperative ICG fluorescence and AR navigation, the anterior and posterior pancreaticoduodenal arterial arcades were preserved, and the pancreatic cut surface was reconstructed using a modified Blumgart pancreaticojejunostomy, so that curative tumor resection is accomplished while organ function is maximally preserved and patient outcomes are improved. This report is presented as a demonstration of the technical feasibility of completing each step of the protocol; its safety and effectiveness require evaluation in larger series.