The objective was to present a surgical technique for laparoscopic pancreaticoduodenectomy (LPD) for a tumor of the pancreatic head in a resource-limited setting. The case involved a 55-year-old female patient with a localized tumor of the pancreatic head and a negative metastatic workup. Laparoscopic pancreaticoduodenectomy was indicated. En bloc resection with lymphadenectomy was performed, and reconstruction followed the Child technique. The specimen was extracted through a small midline incision, and two drains were placed. The operative time was 630 minutes, with estimated blood loss of 300 cc. Postoperative care included transfer to the intensive care unit with transfusion of two units of A+ blood, fresh frozen plasma, and initiation of parenteral nutrition. A biliary fistula was observed on postoperative day 4. Conclusion: The development of laparoscopic pancreatic surgery has been slow due to the anatomical location of the pancreas, the technical difficulty of the procedure, the low number of patients with localized tumors, and a lack of appropriate equipment in our region.
References
[1]
Whipple, A.O., Parsons, W.B. and Mullins, C.R. (1935) Treatment of Carcinoma of the Ampulla of Vater. Annals of Surgery, 102, 763-779. https://doi.org/10.1097/00000658-193510000-00023
[2]
Nigri, G., Petrucciani, N., La Torre, M., Magistri, P., Valabrega, S., Aurello, P., et al. (2014) Duodenopancreatectomy: Open or Minimally Invasive Approach? The Surgeon, 12, 227-234. https://doi.org/10.1016/j.surge.2014.01.006
[3]
Li, L., Bo, Z., Liu, Q., Wang, G., Zhang, W. and Liang, Q. (2023) Comparative Analysis of Clinical Efficacy between Laparoscopic and Open Pancreaticoduodenectomy. Medicine, 102, e33588. https://doi.org/10.1097/md.0000000000033588
[4]
Mimmo, A., Al-Sadairi, A.R., Rhaiem, R., Rached, L.J., Tashkandi, A., Zimmermann, P., et al. (2020) Laparoscopic Pancreatoduodenectomy Using the “Hybrid” Technique: An Improvement over the Traditional Dissection Technique. Journal de Chirurgie Viscérale, 157, S162. https://doi.org/10.1016/j.jchirv.2020.07.063
[5]
Li, D., Du, C., Wang, W., Zhang, J. and Liu, J. (2023) First Assistant Experience in Total Laparoscopic Pancreaticoduodenectomy: Accelerating the Learning Curve for an Operator. BMC Surgery, 23, Article No. 92. https://doi.org/10.1186/s12893-023-01987-8
[6]
Silviu-Tiberiu, M., Vito, D.B., Alexandru, M.M., Luca, A., Martine, G. and Santiago, A.J. (2025) Laparoscopic Pancreaticoduodenectomy after Roux-en-Y Gastric Bypass: Case Report and Literature Review. Case Reports in Surgery, 2025, Article ID: 9982214. https://doi.org/10.1155/cris/9982214
[7]
Staudacher, C., Orsenigo, E., Baccari, P., Palo, S.D. and Crippa, S. (2005) Laparoscopic Assisted Duodenopancreatectomy. Surgical Endoscopy, 19, 352-356. https://doi.org/10.1007/s00464-004-9055-y
[8]
Boggi, U., Amorese, G., Vistoli, F., Caniglia, F., De Lio, N., Perrone, V., et al. (2015) Laparoscopic Pancreaticoduodenectomy: A Systematic Literature Review. Surgical Endoscopy, 29, 9-23. https://doi.org/10.1007/s00464-014-3670-z
[9]
Zimmerman, A.M., Roye, D.G. and Charpentier, K.P. (2018) A Comparison of Outcomes between Open, Laparoscopic and Robotic Pancreaticoduodenectomy. HPB, 20, 364-369. https://doi.org/10.1016/j.hpb.2017.10.008
[10]
Zhou, H., Yu, S., Wu, X. and Li, X. (2022) Application of Purse String Suture Pancreaticojejunostomy for Undilated Pancreatic Duct in Total Laparoscopic Pancreaticoduodenectomy. BMC Surgery, 22, Article No. 195. https://doi.org/10.1186/s12893-022-01640-w
[11]
Wang, M., Pan, S., Qin, T., Xu, X., Huang, X., Liu, J., et al. (2023) Short-Term Outcomes Following Laparoscopic vs Open Pancreaticoduodenectomy in Patients with Pancreatic Ductal Adenocarcinoma. JAMA Surgery, 158, 1245-1253. https://doi.org/10.1001/jamasurg.2023.5210
[12]
Kamarajah, S.K., Bundred, J.R., Marc, O.S., Jiao, L.R., Hilal, M.A., Manas, D.M., et al. (2020) A Systematic Review and Network Meta-Analysis of Different Surgical Approaches for Pancreaticoduodenectomy. HPB, 22, 329-339. https://doi.org/10.1016/j.hpb.2019.09.016
[13]
Kabir, T., Tan, H.L., Syn, N.L., Wu, E.J., Kam, J.H. and Goh, B.K.P. (2022) Outcomes of Laparoscopic, Robotic, and Open Pancreatoduodenectomy: A Network Meta-Analysis of Randomized Controlled Trials and Propensity-Score Matched Studies. Surgery, 171, 476-489. https://doi.org/10.1016/j.surg.2021.07.020
[14]
Zhang, Z., Yin, T., Qin, T., Pan, S., Wang, M., Zhang, H., et al. (2022) Comparison of Laparoscopic versus Open Pancreaticoduodenectomy in Patients with Resectable Pancreatic Ductal Adenocarcinoma: A Propensity Score-Matching Analysis of Long-Term Survival. Pancreatology, 22, 317-324. https://doi.org/10.1016/j.pan.2021.12.005
[15]
de Rooij, T., van Hilst, J., Bosscha, K., Dijkgraaf, M.G., Gerhards, M.F., Groot Koerkamp, B., et al. (2018) Minimally Invasive versus Open Pancreatoduodenectomy (LEOPARD-2): Study Protocol for a Randomized Controlled Trial. Trials, 19, Article No. 1. https://doi.org/10.1186/s13063-017-2423-4
