full laparoscopie pancreaticoduodenumectomy: technic’s description

Background]the feasibility of safe full laparoscopic cephalic duodenopancreatectomy (cdp) has been demonstrated by several authors.[objectives]for its realization, we propose a 5 trocars approach.[methods]kocher maneuver is performed to reach the inferior vena cava, the infrarenal aorta, the rear plate of the uncinate process, and the superior mesenteric artery. lymphadenectomy in the region can be done in a comprehensive way; interaortico cave, around the hepaticoduodenal ligament, and the celiac trunk and its branches. after dissection of the portal vein (pv), the pancreas can be cut away from the tumor, and its right part is separated from the pv. the duodenal bulb and the first jejunal loop are cut using a linear stapler. after cholecystectomy, the bile duct is cut upstream of the cystic.[results]the reconstruction will include three anastomoses: terminolateral posterior pancreatogastric by telescoping, endtoside duodenojejunal and endtoside hepaticojejunal anastomoses.[conclusions]the cephalic duodenopancreatectomy (cdp) is entirely feasible laparoscopically. in obese patients, the cpd is more simple by laparoscopy. of course, performing this complex procedure requires a careful selection of patients and an experienced surgical team.