LAPAROSCOPIC-ASSISTED (HYBRID) DUODENOPANCREATECTOMY: SAFE OPTION FOR PANCREATIC RESECTION ON THE MANAGEMENT OF MAIN DUCT IPMN

Introduction: the benefits of minimally invasive access observed during left pancreatectomies have made laparoscopic surgery gain wide acceptance on the treatment of pancreatic benign and pre-malignant lesions. The same acceptance was not observed on resections for lesions located on the head of the pancreas, which imply in operations with higher degree of complexity, in which laparoscopic surgery is still controversial as it may have worse results than the conventional approach. Method: Description of surgical steps for laparoscopic-assisted (hybrid) duodenopancreatectomy (DP). Method: 62 years-old female patient with recurrent episodes of acute pancreatitis during the past year. Abdominal magnetic resonance identified segmental pancreatic main duct dilation, located on the head of the pancreas, with 12 millimeters diameter and radiological aspect compatible with intraductal pancreatic mucinous neoplasia (IPMN). Patient undergone surgical treatment with laparoscopic-assisted (hybrid) access, with resection carried out during laparoscopic phase and reconstruction performed through an auxiliary 15 centimeters incision during the conventional phase of the operation. Patient was placed in French position with reverse Trendelemburg. Six ports were used, a 30 degree 10 millimeters optical was employed and advanced bipolar energy was applied during resection. The pylorus was resected, gastric drainage was performed with a Roux-en-Y reconstruction, pancreatic and biliary anastomosis were on a single loop and pancreatojejunal anastomosis was performed with duct-to-mucosa technique. Results: operative time was 330 minutes, estimated blood loss was 200 milliliters. Patient recovered uneventfully and was discharged on the 7th postoperative day. Final pathologic report confirmed a main duct IPMN with moderate dysplasia, free margins. Conclusion: the adverse events related to total laparoscopic DP on a recent prospective trial can be better managed with changing approach, from pure laparoscopic to laparoscopic-assisted (hybrid) access, an operation in which the benefits of minimally invasive surgery during resection can be associated with the safety of conventional surgery during reconstruction.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019