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Development of a novel approach to reduce the difficulty of laparoscopic pancreatoduodenectomy
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Yuichi Nagakawa1,
Yatsuka Sahara1,
Akihiko Tsuchida1 |
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1Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University |
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| Recently, laparoscopic pancreaticoduodenectomy (LPD) has been used as a novel minimally invasive surgery. However, advanced laparoscopic skills are required. Therefore, techniques to reduce the difficulty of LPD are needed. The visual field for LPD is different from that of open surgery. Even experts of laparoscopic surgery may increase the difficulty if the surgical field is not secured, increase surgical time and blood loss, and cause vascular injury. The establishment of effective retraction methods is important at each site to achieve an effective three-way retraction. Although the artery-first approach is widely used in open pancreaticoduodenectomy, it is difficult to laparoscopically expose the origin of the IPDA from left side of the SMA. We introduce the proximal dorsal jejunal vein (PDJV) preisolation method which facilitate approaching the SMA from the right side of the SMA under good surgical field. Although the mean operation time from the initial cases to 47 cases (Hybrid PD) was 551.6 (374-646) minutes, operation time from 61 to 78 cases was significantly reduced from the initial cases was significantly decrease (415.3min; 370-480) by the above attempt. We introduce our approaches to reduce surgical difficulty of LPD. |
Index Term 1: Laparoscopic pancreaticoduodenectomy
Index Term 2: pancreaticoduodenectomy |
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