Laparoscopic pancreaticoduodenectomy

Laparoscopic procedures have become an important part of minimally invasive surgery for pancreatic disease. However, due to the complex anatomic location and numerous reconstructions, laparoscopic pancreaticoduodenectomy (LPD) still remains one of the most challenging procedures even for the experienced laparoscopic surgeons. Owing to the evolution in laparoscopic technology and instrumentation within the past decade, LPD is beginning to gain wider acceptance. In contrast to the traditional open procedures, LPD has been showed to improve perioperative outcomes, such as less blood loss, decreased postoperative pain, shorter hospital stay and faster recovery. According to our experience, LPD has the same indications as the open procedures, including the cases with SMV or PV been invaded. However, abundant experience in open surgery and strict laparoscopic technique training are still play an important role in this procedure. Here we propose the posterior approach, and sum up the dissection processes as “Three axis and four visual fields”. In order to shorter the operative time, vessels should be taken as the axis, dissection should be performed from the distant towards the portal and every visual field should be made full use of. However, prospective RCTs of LPD are still absence. We are looking forward to adding more surgeons to promote LPD, working together to identify its superiority and long-term advantages over the open counterpart and making it become the gold standard for the treatment of periampullary diseases.