Sitzung

27 - Freie Mitteilung
HPB I
15. Mai 2019, 15:30 - 17:00, Bellavista 2, 6. OG

Abstract

3
Video: Challenging technical aspects of laparoscopic pancreaticoduodenectomy
T. Haltmeier, A. Andreou, J. Hillner, D. Candinas, M. Worni, B. Gloor, Presenter: T. Haltmeier (Bern)

Ziel
Short-term postoperative and oncological outcomes of laparoscopic (LPD) and open pancreaticoduodenectomy (OPD) have been shown to be equivalent in highly experienced centers. However, LPD is a technically demanding procedure with a long learning curve. This video presentation shows specific challenging technical aspects of LPD.
Methoden
All patients presented underwent LPD or laparoscopy-assisted resection for pancreatic head cancer at a Swiss University Hospital. Procedures were video-recorded. Videos were subsequently edited to show specific technical aspects of LPD.
Resultate
The following important aspects of LPD are demonstrated in this video: - Exposure of a replaced right hepatic artery (RRHA): Contrast-enhanced computed tomography of the abdomen for precise preoperative assessment of the vascular anatomy is crucial. The RRHA typically runs dorsal to the portal vein and dorsolateral to the common bile duct. Exposure is recommended from lateral to medial and from posterior to anterior within the hepatoduodenal ligament. - Temporary clamping of the gastroduodenal artery (GDA): To ensure sustained hepatic arterial flow after transection of the GDA, this artery has to be temporarily clamped before being clipped and transected. - Removal of a hepatogastrostomy (HGS) stent: In patients with bile duct obstruction and technical failure of endoscopic retrograde cholangiography, routine endoscopic HGS is performed in our institution. The stent is removed intraoperatively with suture closure of the hepatic defect and the gastrostomy. - Laparoscopic biliodigestive and pancreatic anastomosis: Both, the end-to-side hepaticojejunostomy and end-to-side duct-to-mucosa pancreaticojejunostomy are performed in a running suture technique. Proper visualization and mobilization of the dorsal aspect of the bile duct and pancreatic remnant are paramount.
Schlussfolgerung
The technical aspects presented in this video may help shortening learning curves and improving surgical outcomes for this demanding laparoscopic procedure.
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