Management of the uncinate process via the artery first approach in laparoscopic pancreatoduodenectomy

Background Uncinate process dissection is one of the major challenges for surgeons when performing laparoscopic pancreatoduodenectomy. This study aimed to evaluate the artery first approach for handling uncinate process dissection in laparoscopic pancreatoduodenectomy. Methods Between February 2015...

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Published in:Journal of hepato-biliary-pancreatic sciences 2019-09, Vol.26 (9), p.410-415
Main Authors: Jiang, Chong‐Yi, Liang, Yun, Wang, Hong‐Wei, Hu, Peng‐Fei, Cai, Zhi‐Wei, Wang, Wei
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Blood Loss, Surgical
Dissection
Female
Humans
Laparoscopy
Laparoscopy - methods
Lymph Node Excision
Male
Mesenteric Artery, Superior - surgery
Middle Aged
Operative Time
Pancreatic Neoplasms - surgery
Pancreaticoduodenectomy
Pancreaticoduodenectomy - methods
Pancreatoduodenectomy
Postoperative Complications
Short‐term outcome
Uncinate process
Veins & arteries
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Summary:Background Uncinate process dissection is one of the major challenges for surgeons when performing laparoscopic pancreatoduodenectomy. This study aimed to evaluate the artery first approach for handling uncinate process dissection in laparoscopic pancreatoduodenectomy. Methods Between February 2015 and June 2018, a total of 91 consecutive patients without vascular encasement underwent selective laparoscopic pancreatoduodenectomy, including the first 26 consecutive cases treated with the conventional approach and the remaining 65 with the artery first approach applied for uncinate process dissection. Here, we present and analyze the surgical outcomes and the oncological results for the two groups. Results There was no significant difference between the two groups in operative time, intraoperative blood loss, the rate of conversion to open pancreatoduodenectomy, postoperative complications, mortality, as well as the number of lymph nodes retrieved in the malignancies. In contrast, the artery first approach group showed a statistically significant shorter resection time and a higher R0 resection rate when compared with the conventional group. Conclusions The artery first approach is a safe and feasible technique that can be used for uncinate process management in laparoscopic pancreatoduodenectomy for patients without vascular encasement. It also has the advantage of increased rate of radical resection in the surgical intervention of relevant malignancies. Highlight Jiang and colleagues evaluated the artery first approach for uncinate process dissection, which is one of the major challenges in laparoscopic pancreatoduodenectomy. They concluded that it is safe and feasible, and recommended it as a standard technique for handling the uncinate process in laparoscopic pancreatoduodenectomy for cases without vascular involvement.
ISSN:1868-6974
1868-6982
DOI:10.1002/jhbp.647