The feasibility of laparoscopic pancreaticoduodenectomya stepwise procedure and learning curve

Background Laparoscopic pancreaticoduodenectomy (LPD) has been proven feasible and safe. The artery-first approach emerged as a standard procedure in pancreatic surgery. In this manuscript, we describe both our stepwise, artery-first technique for LPD and methods for accumulating experience during the initial learning stage. Method This is a retrospective review of 12 patients who underwent LPD between 2012 and 2015. We classified the first five patients as the early group and the remaining seven as the late group. Here, we present our stepwise procedure for LPD, along with the perioperative results and postoperative prognoses for the two groups. Results The mean operative time for the 12 patients undergoing LPD was 408.3 +/- 97.5 min. The average blood loss was 146.7 +/- 90.2 mL. The dissection time (TD) was significantly shorter in the late group compared with the early group (140 vs. 200 min, respectively; p = 0.006). However, there was no difference in the reconstruction time (TR) between the two groups (220 vs. 200 min; p = 0.807). Conclusion Artery-first LPD is a feasible procedure for selected patients and has acceptable results. Using this stepwise procedure, the operative time could be reduced, mainly by reducing the time required for dissection.