Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2015; 21(5): 1588-1594
Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1588
Laparoscopic pancreaticoduodenectomy via a reverse-''V'' approach with four ports: Initial experience and perioperative outcomes
Zhao Liu, Mu-Chuan Yu, Rui Zhao, Yan-Feng Liu, Jian-Ping Zeng, Xian-Qiang Wang, Jing-Wang Tan
Zhao Liu, Department of Hepatobiliary and Pancreatic Surgery, Jinan Central Hospital, Shandong University, Jinan 250012, Shandong Province, China
Mu-Chuan Yu, Department of Hepatobiliary Surgery, Zhangqiu People’s Hospital, Affiliated Hospital of Jining Medical University, Jinan 250200, Shandong Province, China
Rui Zhao, Yan-Feng Liu, Xian-Qiang Wang, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Jian-Ping Zeng, Department of Hepatobiliary Surgery, Changgeng Hospital, Affiliated to Tsinghua University, Beijing 100048, China
Jing-Wang Tan, Department of Hepatobiliary Surgery, Hainan Hospital, the Chinese PLA General Hospital, Sanya 572000, Hainan, China
Author contributions: Zeng JP and Tan JW conceived and designed the study; Liu Z, Zhao R, Liu YF, and Wang XQ analyzed the data; Yu MC and Tan JW wrote the paper; all of the authors have read and approved the final manuscript for publication.
Supported by National Natural Science Funds of China, No. 81302123; and Grants from the Chinese Ministry of Health, No. 200802012.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jing-Wang Tan, MD, Department of Hepatobiliary Surgery, Hainan Hospital, the Chinese PLA General Hospital, Sanya 572000, Hainan, China. tanjingwang02@aliyun.com
Telephone: +86-10-66848633 Fax: +86-10-66848636
Received: January 13, 2014
Peer-review started: January 14, 2014
First decision: March 4, 2014
Revised: March 31, 2014
Accepted: May 19, 2014
Article in press: May 23, 2014
Published online: February 7, 2015
Processing time: 391 Days and 21.8 Hours
Abstract

AIM: To evaluate the feasibility, safety, and efficacy of laparoscopic pancreaticoduodenectomy (LPD) using a reverse-“V” approach with four ports.

METHODS: This is a retrospective study of selected patients who underwent LPD at our center between April 2011 and April 2012. The following data were collected and reviewed: patient characteristics, tumor histology, surgical outcome, resection margins, morbidity, and mortality. All patients were thoroughly evaluated preoperatively by complete hematologic investigations, triple-phase helical computed tomography, upper gastrointestinal endoscopy, and biopsy of ampullary lesions (when present). Magnetic resonance cholangiopancreatography was performed for doubtful cases of lower common bile duct lesions.

RESULTS: There was no perioperative mortality. LPD was performed with tumor-free margins in all patients, including patients with pancreatic ductal adenocarcinoma (n = 6), ampullary carcinoma (n = 6), intra-ductal papillary mucinous neoplasm (n = 2), pancreatic cystadenocarcinoma (n = 2), pancreatic head adenocarcinoma (n = 3), and bile duct cancer (n = 2). The mean patient age was 65 years (range, 42-75 years). The median blood loss was 240 mL, and the mean operative time was 368 min.

CONCLUSION: LPD using a reverse-“V” approach can be performed safely and yields good results in elective patients. Our preliminary experience showed that LDP can be performed via a reverse-“V” approach. This approach can be used to treat localized malignant lesions irrespective of histopathology.

Keywords: Laparoscopic pancreaticoduodenectomy; Operation; Indications

Core tip: Laparoscopic pancreaticoduodenectomy via reverse -“V” approach can be performed with safety and obtain good results in elective patients. The preliminary experience showed a good prospect via reverse-“V” approach for LDP. Localized malignant lesions and irrespective of histopathology may be particularly amenable to this approach.