Preliminary experience of “counter clockwise resection” in total laparoscopic pan-creaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XU Jin , XU Weixue , XING Jian , ZHANG Weiming , WANG Hainan

Department of Pancreatic Surgery, Affiliated Shengjing Hospital of China Medical University, Shenyang 110004, P. R. China;

Corresponding?author：

XU Jin, Email: xujinwang@163.com

Keywords：

pancreaticoduodenectomy; laparoscope; counter clockwise resection

DOI：

10.7507/1007-9424.201702006

Video：

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ObjectiveTo discuss application of " counter clockwise resection” in total laparoscopic pan-creaticoduodenectomy (TLPD) and summarize it’s preliminary experiences.MethodThe clinical data of consecutive 8 patients underwent TLPD in the Department of Pancreatic Surgery, Affiliated Shengjing Hospital of China Medical University from July 2016 to January 2017 were analyzed retrospectively.ResultsThere were 3 males and 5 females in these 8 patients. The age was (64.13±15.01) years. The results of postoperative pathology included 1 duodenal cancer, 2 distal biliary tract cancers, 4 pancreatic head cancers, and 1 solid pseudopapillary tumor of pancreatic head. All the 8 patients were performed with TLPD successfully, and the time of the operation was (527.50±69.44) min, the resection time of the specimen was (241.25±38.71) min, and the blood loss was (368.75±162.43) mL, the postoperative hospitalization stay was (18.67±4.00) d. There were no postoperative bleeding, perioperative death, and delayed gastric emptying．Four patients suffered from the pancreatic fistula including 3 cases of grade A and 1 case of grade B pancreatic fistulas, and 1 case suffered from the intra-abdominal infection, who were cured after the conservative treatment. All the patients were following-up, and there was no abnormality.ConclusionPreliminary results of limited cases in this study show that " counter clockwise resection” might be a safe, effective, and easy method of TLPD, but further research is need to study.

Citation： XU Jin, XU Weixue, XING Jian, ZHANG Weiming, WANG Hainan. Preliminary experience of “counter clockwise resection” in total laparoscopic pan-creaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(9): 1090-1094. doi: 10.7507/1007-9424.201702006 Copy

1.	Burkhart RA, Javed AA, Ronnekleiv-Kelly S, et al. The use of negative pressure wound therapy to prevent post-operative surgical site infections following pancreaticoduodenectomy. HPB (Oxford), 2017 Jun 8. S1365-182 X(17) 30595-6. [Epub ahead of print].
2.	Bergquist JR, Shubert CR, Ubl DS, et al. Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program. HPB (Oxford), 2016, 18(11): 900-907.
3.	Njoku VC, Howard TJ, Shen C, et al. Pyogenic liver abscess following pancreaticoduodenectomy: risk factors, treatment, and long-term outcome. J Gastrointest Surg, 2014, 18(5): 922-928.
4.	Jaap K, Hunsinger M, Dove J, et al. Morphometric predictors of morbidity after pancreatectomy. Am Surg, 2016, 82(12): 1221-1226.
5.	Gleeson EM, Shaikh MF, Shewokis PA, et al. WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database. Surgery, 2016, 160(5): 1279-1287.
6.	Zouros E, Liakakos T, Machairas A, et al. Fast-track pancreaticoduodenectomy in the elderly. Am Surg, 2017, 83(3): 239-249.
7.	Adam MA, Thomas S, Youngwirth L, et al. Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg, 2017, 152(4): 336-342.
8.	Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
9.	盧榜裕, 陸文奇, 蔡小勇, 等. 腹腔鏡胰十二指腸切除治療十二指腸乳頭癌一例報告. 中國微創外科雜志, 2003, 3(3): 197-198.
10.	Adam MA, Choudhury K, Dinan MA, et al. Minimally invasive versus open pancreaticoduodenectomy for cancer: Practice patterns and short-term outcomes among 7 061 patients. Ann Surg, 2015, 262(2): 372-377.
11.	Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg, 2010, 145(1): 19-23.
12.	Palanivelu C, Rajan PS, Rangarajan M, et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg, 2009, 16(6): 731-740.
13.	Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg, 2012, 215(6): 810-819.
14.	Zureikat AH, Moser AJ, Boone BA, et al. 250 robotic pancreatic resections: safety and feasibility. Ann Surg, 2013, 258(4): 554-562.
15.	Kim SC, Song KB, Jung YS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc, 2013, 27(1): 95-103.
16.	Chalikonda S, Aguilar-Saavedra JR, Walsh RM. Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc, 2012, 26(9): 2397-2402.
17.	Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Surg Endosc, 2006, 20(7): 1045-1050.
18.	Pugliese R, Scandroglio I, Sansonna F, et al. Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech, 2008, 18(1): 13-18.
19.	Bencini L, Annecchiarico M, Farsi M, et al. Minimally invasive surgical approach to pancreatic malignancies. World J Gastrointest Oncol, 2015, 7(12): 411-421.
20.	中華醫學會外科學分會胰腺外科學組, 中國醫療保健國際交流促進會胰腺病分會胰腺微創治療學組, 中國研究型醫院學會胰腺疾病專業委員會胰腺微創學組, 等. 腹腔鏡胰十二指腸切除手術專家共識(附: 手術流程與主要步驟). 中華外科雜志, 2017, 55(5): 335-339.
21.	Jacobs MJ, Kamyab A. Total laparoscopic pancreaticoduodenectomy. JSLS, 2013, 17(2): 188-193.
22.	魯超, 金巍巍, 牟一平, 等. 腹腔鏡胰十二指腸切除術的學習曲線. 外科理論與實踐, 2015, 20(6): 485-489.
23.	林浩銘, 李國林, 常瑞明, 等. 動脈入路腹腔鏡胰十二指腸切除 19 例報道. 中國普外基礎與臨床雜志, 2014, 21(10): 1237-1240.
24.	孫躍明, 苗毅. 腹腔鏡胰十二指腸切除術應用及其評價. 中國實用外科雜志, 2010, 30(3): 190-192.
25.	洪德飛, 張宇華, 張成武, 等. 腔鏡胰十二指腸切除術在壺腹周圍癌中的應用. 中國普外基礎與臨床雜志, 2016, 23(4): 393-397.
26.	張華, 王明俊, 王昕, 等. 腹腔鏡胰十二指腸切除術 45 例體會. 中國普外基礎與臨床雜志, 2014, 21(8): 940-945.
27.	李敬東, 李勇, 冷政偉, 等. 縮短腹腔鏡胰十二指腸切除術學習曲線的經驗. 中國普外基礎與臨床雜志, 2016, 23(4): 398-402.
28.	金巍巍, 徐曉武, 牟一平, 等. 腹腔鏡胰十二指腸切除術 66 例初步經驗總結. 中華外科雜志, 2016, 54(2): 84-88.
29.	金巍巍, 徐曉武, 牟一平, 等. 腹腔鏡胰十二指腸切除術單中心 233 例臨床經驗總結. 中華外科雜志, 2017, 55(5): 354-358.
30.	Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.

1. Burkhart RA, Javed AA, Ronnekleiv-Kelly S, et al. The use of negative pressure wound therapy to prevent post-operative surgical site infections following pancreaticoduodenectomy. HPB (Oxford), 2017 Jun 8. S1365-182 X(17) 30595-6. [Epub ahead of print].
2. Bergquist JR, Shubert CR, Ubl DS, et al. Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program. HPB (Oxford), 2016, 18(11): 900-907.
3. Njoku VC, Howard TJ, Shen C, et al. Pyogenic liver abscess following pancreaticoduodenectomy: risk factors, treatment, and long-term outcome. J Gastrointest Surg, 2014, 18(5): 922-928.
4. Jaap K, Hunsinger M, Dove J, et al. Morphometric predictors of morbidity after pancreatectomy. Am Surg, 2016, 82(12): 1221-1226.
5. Gleeson EM, Shaikh MF, Shewokis PA, et al. WHipple-ABACUS, a simple, validated risk score for 30-day mortality after pancreaticoduodenectomy developed using the ACS-NSQIP database. Surgery, 2016, 160(5): 1279-1287.
6. Zouros E, Liakakos T, Machairas A, et al. Fast-track pancreaticoduodenectomy in the elderly. Am Surg, 2017, 83(3): 239-249.
7. Adam MA, Thomas S, Youngwirth L, et al. Defining a hospital volume threshold for minimally invasive pancreaticoduodenectomy in the United States. JAMA Surg, 2017, 152(4): 336-342.
8. Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc, 1994, 8(5): 408-410.
9. 盧榜裕, 陸文奇, 蔡小勇, 等. 腹腔鏡胰十二指腸切除治療十二指腸乳頭癌一例報告. 中國微創外科雜志, 2003, 3(3): 197-198.
10. Adam MA, Choudhury K, Dinan MA, et al. Minimally invasive versus open pancreaticoduodenectomy for cancer: Practice patterns and short-term outcomes among 7 061 patients. Ann Surg, 2015, 262(2): 372-377.
11. Kendrick ML, Cusati D. Total laparoscopic pancreaticoduodenectomy: feasibility and outcome in an early experience. Arch Surg, 2010, 145(1): 19-23.
12. Palanivelu C, Rajan PS, Rangarajan M, et al. Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg, 2009, 16(6): 731-740.
13. Asbun HJ, Stauffer JA. Laparoscopic vs open pancreaticoduodenectomy: overall outcomes and severity of complications using the Accordion Severity Grading System. J Am Coll Surg, 2012, 215(6): 810-819.
14. Zureikat AH, Moser AJ, Boone BA, et al. 250 robotic pancreatic resections: safety and feasibility. Ann Surg, 2013, 258(4): 554-562.
15. Kim SC, Song KB, Jung YS, et al. Short-term clinical outcomes for 100 consecutive cases of laparoscopic pylorus-preserving pancreatoduodenectomy: improvement with surgical experience. Surg Endosc, 2013, 27(1): 95-103.
16. Chalikonda S, Aguilar-Saavedra JR, Walsh RM. Laparoscopic robotic-assisted pancreaticoduodenectomy: a case-matched comparison with open resection. Surg Endosc, 2012, 26(9): 2397-2402.
17. Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Surg Endosc, 2006, 20(7): 1045-1050.
18. Pugliese R, Scandroglio I, Sansonna F, et al. Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech, 2008, 18(1): 13-18.
19. Bencini L, Annecchiarico M, Farsi M, et al. Minimally invasive surgical approach to pancreatic malignancies. World J Gastrointest Oncol, 2015, 7(12): 411-421.
20. 中華醫學會外科學分會胰腺外科學組, 中國醫療保健國際交流促進會胰腺病分會胰腺微創治療學組, 中國研究型醫院學會胰腺疾病專業委員會胰腺微創學組, 等. 腹腔鏡胰十二指腸切除手術專家共識(附: 手術流程與主要步驟). 中華外科雜志, 2017, 55(5): 335-339.
21. Jacobs MJ, Kamyab A. Total laparoscopic pancreaticoduodenectomy. JSLS, 2013, 17(2): 188-193.
22. 魯超, 金巍巍, 牟一平, 等. 腹腔鏡胰十二指腸切除術的學習曲線. 外科理論與實踐, 2015, 20(6): 485-489.
23. 林浩銘, 李國林, 常瑞明, 等. 動脈入路腹腔鏡胰十二指腸切除 19 例報道. 中國普外基礎與臨床雜志, 2014, 21(10): 1237-1240.
24. 孫躍明, 苗毅. 腹腔鏡胰十二指腸切除術應用及其評價. 中國實用外科雜志, 2010, 30(3): 190-192.
25. 洪德飛, 張宇華, 張成武, 等. 腔鏡胰十二指腸切除術在壺腹周圍癌中的應用. 中國普外基礎與臨床雜志, 2016, 23(4): 393-397.
26. 張華, 王明俊, 王昕, 等. 腹腔鏡胰十二指腸切除術 45 例體會. 中國普外基礎與臨床雜志, 2014, 21(8): 940-945.
27. 李敬東, 李勇, 冷政偉, 等. 縮短腹腔鏡胰十二指腸切除術學習曲線的經驗. 中國普外基礎與臨床雜志, 2016, 23(4): 398-402.
28. 金巍巍, 徐曉武, 牟一平, 等. 腹腔鏡胰十二指腸切除術 66 例初步經驗總結. 中華外科雜志, 2016, 54(2): 84-88.
29. 金巍巍, 徐曉武, 牟一平, 等. 腹腔鏡胰十二指腸切除術單中心 233 例臨床經驗總結. 中華外科雜志, 2017, 55(5): 354-358.
30. Stauffer JA, Coppola A, Villacreses D, et al. Laparoscopic versus open pancreaticoduodenectomy for pancreatic adenocarcinoma: long-term results at a single institution. Surg Endosc, 2017, 31(5): 2233-2241.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preliminary experience of “counter clockwise resection” in total laparoscopic pan-creaticoduodenectomy

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