Total Laparoscopic Pancreaticoduodenectomy: A Single-center Experience of 33 Cases in Patients with Periampullary Tumor—Lessons Learnt

Ab s t r Ac t Introduction: The introduction of minimally invasive procedures has revolutionized surgical practice worldwide. However, its application to total pancreaticoduodenectomy since its inception in 1994 by Gagner and Pomp has elicited reluctance and skepticism due to the need for expertise, advanced laparoscopy skills, long operative time, difficulty in adhering to oncological principles of resection, and high rates of conversion to open surgery. Materials and methods: A retrospective review of 33 patients who underwent total laparoscopic pancreaticoduodenectomy at a tertiary care center in Mumbai from May 2015 to December 2019 was performed. All cases were operated by the principal investigator. Patients with malignancy on final histopathology report were included in the study. Patients with involvement of major vessels on preoperative contrastenhanced computed tomography scan, distant metastasis, and contraindication to general anesthesia were excluded from the study. Perioperative data were collected and analyzed. Results: Thirty-three patients were operated for total laparoscopic pancreaticoduodenectomy. The average operative time was 330 minutes. Only one patient required conversion to open surgery and postoperative blood transfusion. The resection margins were negative in all the patients with an average lymph node retrieval rate of 12 nodes. There was no postoperative mortality. Conclusion and clinical significance: Total laparoscopic pancreaticoduodenectomy is a safe and feasible procedure with standard laparoscopic setup in patients with malignant periampullary disease.