J.Jpn. Surg. Soc.. 120(4): 405-412, 2019

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Feature topic

INTRODUCTION OF MINIMALLY INVASIVE PANCREATICODUODENECTOMY INCLUDING LAPAROSCOPIC AND ROBOTIC-ASSISTED APPROACHES

Recently, minimally invasive pancreaticoduodenectomy (MIPD) such as laparoscopic pancreaticoduodenectomy (LPD) and robotic-assisted pancreaticoduodenectomy (RPD) has been introduced. However, MIPD is a technically demanding procedure that requires precise vascular dissection and pancreaticojejunostomy under motion restriction. Our attempts to standardize MIPD include a semi-derotation technique for safer tumor resection and vascular dissection and wrapping double-mattress anastomosis (Kiguchi method) for secure pancreaticojejunostomy. After the introduction of these techniques, we have not experienced clinically relevant postoperative pancreatic fistulas after performing 13 consecutive LPDs and 8 consecutive RPDs. The benefits of RPD over LPD are currently unclear, but RPD is expected to provide superior outcomes in difficult cases once its challenges are overcome in the future.

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