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An Orthotopic Resection Surgical Technique Using an Inferior Infracolic Approach for Laparoscopic Pancreaticoduodenectomy

The no-touch isolation technique has been widely used in cancer surgery as a strategy to prevent cancer cells from spreading; however, it is difficult to apply in laparoscopic pancreaticoduodenectomy (LPD). Here, we describe an orthotopic resection surgical technique that applies a no-touch principl...

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Autores principales: Yao, Yutong, Xiong, Junjie, Wang, Ziyao, Wang, Xing, Liu, Xubao, Ke, Nengwen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9862277/
https://www.ncbi.nlm.nih.gov/pubmed/36675519
http://dx.doi.org/10.3390/jcm12020590
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author Yao, Yutong
Xiong, Junjie
Wang, Ziyao
Wang, Xing
Liu, Xubao
Ke, Nengwen
author_facet Yao, Yutong
Xiong, Junjie
Wang, Ziyao
Wang, Xing
Liu, Xubao
Ke, Nengwen
author_sort Yao, Yutong
collection PubMed
description The no-touch isolation technique has been widely used in cancer surgery as a strategy to prevent cancer cells from spreading; however, it is difficult to apply in laparoscopic pancreaticoduodenectomy (LPD). Here, we describe an orthotopic resection surgical technique that applies a no-touch principle for LPD and can help with the in situ resection of tumors. In implementing this surgical strategy, Kocher’s maneuver was not performed first. Instead, after the exploration of the abdominal cavity, the distal stomach and the pancreatic neck were transected. Then, the dissection of the uncinate process of the pancreas, the duodenum, and the superior mesenteric vein and artery is carried out via an inferior infracolic approach. Finally, the pancreatic head and duodenum were removed in situ. Among the 41 patients who underwent this technique, two (4.9%) required conversion to open surgery due to uncontrolled bleeding. The average operative time was 335 min (248–1055 min). The mean estimated blood loss was 300 mL (50–1250 mL). Two patients (4.9%) underwent combined PV resection and reconstruction; six patients (14.6%) required a blood transfusion; two patients (4.9%) suffered from postoperative bleeding; two patients (4.9%) suffered from Grade B pancreatic fistulas; one patient (2.4%) suffered from bile leakage; and three patients (7.3%) suffered from abdominal fluid collection. No patients died during the perioperative period. Therefore, orthotopic LPD using an inferior infracolic approach is safe and feasible for patients with malignant pancreatic head and periampullary tumors. However, further investigations are required to elucidate its oncological benefits.
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spelling pubmed-98622772023-01-22 An Orthotopic Resection Surgical Technique Using an Inferior Infracolic Approach for Laparoscopic Pancreaticoduodenectomy Yao, Yutong Xiong, Junjie Wang, Ziyao Wang, Xing Liu, Xubao Ke, Nengwen J Clin Med Technical Note The no-touch isolation technique has been widely used in cancer surgery as a strategy to prevent cancer cells from spreading; however, it is difficult to apply in laparoscopic pancreaticoduodenectomy (LPD). Here, we describe an orthotopic resection surgical technique that applies a no-touch principle for LPD and can help with the in situ resection of tumors. In implementing this surgical strategy, Kocher’s maneuver was not performed first. Instead, after the exploration of the abdominal cavity, the distal stomach and the pancreatic neck were transected. Then, the dissection of the uncinate process of the pancreas, the duodenum, and the superior mesenteric vein and artery is carried out via an inferior infracolic approach. Finally, the pancreatic head and duodenum were removed in situ. Among the 41 patients who underwent this technique, two (4.9%) required conversion to open surgery due to uncontrolled bleeding. The average operative time was 335 min (248–1055 min). The mean estimated blood loss was 300 mL (50–1250 mL). Two patients (4.9%) underwent combined PV resection and reconstruction; six patients (14.6%) required a blood transfusion; two patients (4.9%) suffered from postoperative bleeding; two patients (4.9%) suffered from Grade B pancreatic fistulas; one patient (2.4%) suffered from bile leakage; and three patients (7.3%) suffered from abdominal fluid collection. No patients died during the perioperative period. Therefore, orthotopic LPD using an inferior infracolic approach is safe and feasible for patients with malignant pancreatic head and periampullary tumors. However, further investigations are required to elucidate its oncological benefits. MDPI 2023-01-11 /pmc/articles/PMC9862277/ /pubmed/36675519 http://dx.doi.org/10.3390/jcm12020590 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Technical Note
Yao, Yutong
Xiong, Junjie
Wang, Ziyao
Wang, Xing
Liu, Xubao
Ke, Nengwen
An Orthotopic Resection Surgical Technique Using an Inferior Infracolic Approach for Laparoscopic Pancreaticoduodenectomy
title An Orthotopic Resection Surgical Technique Using an Inferior Infracolic Approach for Laparoscopic Pancreaticoduodenectomy
title_full An Orthotopic Resection Surgical Technique Using an Inferior Infracolic Approach for Laparoscopic Pancreaticoduodenectomy
title_fullStr An Orthotopic Resection Surgical Technique Using an Inferior Infracolic Approach for Laparoscopic Pancreaticoduodenectomy
title_full_unstemmed An Orthotopic Resection Surgical Technique Using an Inferior Infracolic Approach for Laparoscopic Pancreaticoduodenectomy
title_short An Orthotopic Resection Surgical Technique Using an Inferior Infracolic Approach for Laparoscopic Pancreaticoduodenectomy
title_sort orthotopic resection surgical technique using an inferior infracolic approach for laparoscopic pancreaticoduodenectomy
topic Technical Note
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9862277/
https://www.ncbi.nlm.nih.gov/pubmed/36675519
http://dx.doi.org/10.3390/jcm12020590
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