Laparoscopic Duodenum-Preserving Pancreatic Head Resection via Inferior Infracolic Approach: A Surgical Approach for Benign Lesions

Summary

This article provides a whole technical process of laparoscopic duodenum-preserving pancreatic head resection via an inferior infracolic approach. This is a surgical approach for benign tumors without intraoperative fluorescence image guidance.

Abstract

Minimally invasive pancreatic resections are gaining popularity despite being technically demanding. However, in contrast to laparoscopic pancreatoduodenectomy (LPD), laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) has not yet obtained wide acceptance. This could be attributed to the technical challenges involved in preserving the blood supply of the duodenum and bile duct.

This study describes and demonstrates all the steps of LDPPHR. A 48-year-old woman was diagnosed with a 3.0 cm x 2.5 cm pancreatic head cystic mass, which was detected unexpectedly. The surgery was performed using the 3D laparoscopy via an inferior infracolic approach. The operation lasted approximately 310 min with 100 mL of blood loss. Postoperatively, the patient experienced no complications and was discharged 5 days later. Pathology revealed intraductal papillary mucinous neoplasms.

LDPPHR via an inferior infracolic approach is feasible and safe when performed by experienced surgeons in selected patients with thin mesenteric fat layers. The described technique for LDPPHR via inferior infracolic approach should be well standardized and performed at high-volume centers with experienced surgeons in both open and laparoscopic pancreatology.

Introduction

In 1972, Prof. Berger first proposed the duodenum-preserving pancreatic head resection (DPPHR) and Roux-en-Y pancreatic-enteral reconstruction as a treatment for chronic pancreatitis¹. DPPHR has become the primary surgical treatment for benign lesions of the pancreatic head due to its low incidence of postoperative complications and mortality, as well as its ability to maintain the endocrine and exocrine functions of the pancreas and high remission rate of abdominal pain^2,3,4. DPPHR only removes the diseased pancreatic head while preserving the duodenu....

Protocol

This protocol follows the guidelines of the human research ethics committee of the Sixth Affiliated Hospital, Sun Yat-sen University. Written informed consent was obtained from the patients for performing this study.

NOTE: A 48-year-old female patient presented with an incidental finding of a 3.0 cm x 2.5 cm asymptomatic mass in the head of the pancreas. The patient's clinical history showed a healthy status. Endoscopic ultrasound (EUS) showed a cystic lesion of the pancreatic head.

Discussion

LDPPHR only removes the diseased pancreatic head while preserving the duodenum, stomach, jejunum, common bile duct, and gallbladder that need to be removed in Whipple surgery. Compared to pancreaticoduodenectomy (PD) and pylorus-preserving pancreaticoduodenectomy (PPPD), LDPPHR showed enhancements in mid- and long-term results encompassing hospital stay duration, quality of life, post-surgery recovery, and maintenance of exocrine function^5,14. DPPHR only removes .......

Materials

Name	Company	Catalog Number	Comments
3D Laparoscope	STORZ	TC200,TC302
Cisatracurium Besylate Injection	Hengrui Pharma	H20183042
Drainage catheters	Jiangsu YUBANG MED-DEVICE	YB-B-III
Harmonic ACE Ultrasonic Surgical Devices	Ethicon Endo-Surgery	HAR36
Ligating Clips	Teleflex Medical
Nacrotrend anaesthesia monitoring system	Monitor Technik	Bad Bramsted
Trocar	Ethicon Endo-Surgery	10 mm