Laparoscopic pancreatoduodenectomy is a challenge for the surgeon due to its technical difficulty. The learning curve is long and difficult. Objective. To show the joint experience of two surgeons in more than 100 laparoscopic pancreatoduodenectomy. Material and methods. We analysed all patients treated by laparoscopic pancreatoduodenectomy by two specialist surgeons in the period between May 2012 and May 2018. Inclusion criteria: patients with periampullary disease with indication of pancreatoduodenectomy. Exclusion criteria: patients with evident vascular compromise by images, metastatic disease or bad performance status. Results. Laparoscopic pancreatoduodenectomy was performed in 108 patients; 61 surgeries were totally laparoscopic, 35 were hybrid surgeries, and 12 were converted to open surgery. There was a significant decrease in operative time from case number 30. Twelve surgeries (11.3%) were converted. Pancreatic fistula occurred in 35 of 108 patients (32.4%). Twenty-six patients presented pancreatic fistula type A (24.1%), and 9 (8.3%) fistula B/C. The B/C fistula rate was 8.2% in laparoscopic pancreatic anastomosis, 8.6% in those reconstructed by mini-laparotomy and 8.3% in the converted patients. Reoperation was required (Dindo-Clavien 3) in 19 patients (17.5%). Mortality was 4.6% (5 patients), 2 within 30 days and 3 within 90 days. The median total hospital stay was 8.5 days (range: 4-83). Conclusion. Laparoscopic pancreatoduodenectomy is a viable and reproducible procedure that should be applied in selected cases during the learning curve, increasing its application as the number of operations carried out increases.
Laparoscopic pancreatoduodenectomy in 50 consecutive patients with no mortality: How to beat the learning curve?
