Laparoscopic pancreaticoduodenectomy via a reverse-''V'' approach with four ports:Initial experience and perioperative outcomes

摘要

AIM:To evaluate the feasibility,safety,and efficacy of laparoscopic pancreaticoduodenectomy(LPD) using a reverse-"V" approach with four ports.METHODS:This is a retrospective study of selected patients who underwent LPD at our center between April 2011 and April 2012.The following data were collected and reviewed:patient characteristics,tumor histology,surgical outcome,resection margins,morbidity,and mortality.All patients were thoroughly evaluated preoperatively by complete hematologic investigations,triple-phase helical computed tomography,upper gastrointestinal endoscopy,and biopsy of ampullary lesions(when present).Magnetic resonance cholangiopancreatography was performed for doubtful cases of lower common bile duct lesions.RESULTS:There was no perioperative mortality.LPD was performed with tumor-free margins in all patients,including patients with pancreatic ductal adenocarcinoma(n = 6),ampullary carcinoma(n = 6),intra-ductal papillary mucinous neoplasm(n = 2),pancreatic cystadenocarcinoma(n = 2),pancreatic head adenocarcinoma(n = 3),and bile duct cancer(n = 2).The mean patient age was 65 years(range,42-75 years).The median blood loss was 240 m L,and the mean operative time was 368 min.CONCLUSION:LPD using a reverse-"V" approach can be performed safely and yields good results in elective patients.Our preliminary experience showed that LDP can be performed via a reverse-"V" approach.This approach can be used to treat localized malignant lesions irrespective of histopathology.