Pancreatoduodenectomy
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A pancreaticoduodenectomy, pancreatoduodenectomy, Whipple procedure, or Kausch-Whipple procedure is a major surgical operation most often performed to . A type of surgery used to treat pancreatic cancer. The head of the pancreas, the duodenum, a portion of the stomach, and other nearby tissues are removed.
Some error has occurred while processing your request. Please try after some time. The authors declare no conflict of interests. Annals of Surgery 4 , April Add Item s to:.
Variation in pancreatoduodenectomy as delivered in two national audits
An Existing Folder. A New Folder. The item s has been successfully added to " ". Thanks for registering! Be sure to verify your new user account in the next 24 hours, by checking your email and clicking the "verify" link. User Name Password Sign In. Previous Section Next Section. View larger version: In this window In a new window. Figure 1. Figure 2. The final aspect after resection. Figure 3.
Figure 4.
Pancreatoduodenectomy in Pancreatic and Periampullary Tumors (DUOPAN-EPAM)
Figure 5. Figure 6. Figure 7. The specimen showing vascular invasion. Figure 8. Previous Section. Ann Surg : - , CrossRef Medline Google Scholar. Ann Surg : 10 - 15 , Gastroenterology : - , Ann Surg : 42 - 50 , Medline Google Scholar. World J Surg 27 : - , World J Surg 30 : - , Surgeon 10 : - , Ann Surg : 52 - 60 , J Gastrointest Surg 10 : - , Ann Surg Oncol 17 : - , Cir Esp 92 : - , Surgery : 50 - 55 , Oncology 53 : 47 - 53 , Ann Surg : 81 - 87 , Surgery : 1 - 14 , Oncologist 12 : - , A contraindication for resection?
Pancreatic Tumor Study Group. A case-matched controlled study. J Surg Oncol : 75 - 84 , Ann Surg Oncol 15 : - , Additionally, a worldwide survey showed that the most reported reason for not implementing LPD was lack of specific training 2. Developments in surgical expertise, and instrumentation have improved the feasibility of LPD.
The period encompassed by the later group group 2 in the present study is coincident with the arrival of managed care contracts at our medical center. An outer layer of interrupted, nonabsorbable seromuscular surgical sutures is used to approximate the jejunum to the pancreatic capsule. Write to the Help Desk. Some centers have argued that reconstruction via a mini-laparotomy can be used during the initial learning curve phase One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. Moreover pancreatic resections for pancreatic cancer along with combined resection of the portal vein were performed in cases during
Nevertheless, only few centers have acquired adequate experience with this complex procedure 2. As reflected by recent reports, the learning curve of LPD is demanding. Dokmak et al.
pancreatoduodenectomy
The main factors contributing to the learning curve of the LPD are previous experience and annual case volume of the operating surgeon. Speicher et al. Results, however, vary between centers 4. In addition to the learning phase, a minimum annual volume could be required. Whereas for OPD a minimum annual volume of 40 cases has shown to improve outcome, a minimal annual volume of 30 LPDs is probably required to obtain similar results as from OPD 6. Thus, according to large database analyses, surgical experience of more than 60—80 LPD cases and an annual hospital volume of 22—30 LPD procedures are required to perform LPD with similar outcomes to the open approach 8.
Variation in Drain Management After Pancreatoduodenectomy: E : Annals of Surgery
Now, which interventions can shorten this learning curve and further improve outcomes? This review does not aim to set standards for which centers and which surgeons should or should not perform LPD, but rather presents methods of teaching and implementing LPD as safely as possible. We describe the steps of LPD and beneficial methods of teaching and practicing each step. The operative steps were described previously 9. Methods of teaching and practicing were found by a literature search as described in the Supplementary.
Written informed consent was obtained from the patient for publication of this article and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. The aim of these fellowships is generally to maximize the experience, e.
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Still, laparoscopic box training alone cannot efficiently substitute case load experience. However, acquired laparoscopic skills enable a more specific focus on the complexities of the LPD procedure. The introduction of LPD should be a stepwise approach 3. With essential skills learned at each step and retained by the consecutive step. Preferably, trainees should start with box training of the reconstruction phase, then the resections phase could be performed in cadavers, followed by animate scenario based vascular control and repair, and finally, proctor cases. Meanwhile, video training and performing laparoscopic distal pancreatectomies further benefit the learning retention and preparation for individual cases see Figure 1.
For the stepwise implementation, the trajectory of practicing and teaching the resection phase requires planning, collaboration, and training resources. Practice with cadaver models and animal models provide a representable platform for preparation. Additionally, a sharing platform for videos is ideal to gain advice and feedback from colleagues. The proctor can provide feedback and coaching on video material of the recorded cases or by subsequent visits on-site using a Birkmeyer scoring platform for laparoscopic bariatrics, modified by the University of Pittsburgh Medical Center UPMC Trocar injuries are a noteworthy complication in laparoscopic procedures in general Consequences are severe when not recognized or when inappropriately addressed.
In LPD they could potentially cause enteric and vascular injury, yet reported incidence is low As cadaver models lack blood flow, porcine models serve as a training method to practice trocar placement according to both techniques. The mobilization is characterized by accessing the lesser sack, exposing the pancreatic head and duodenum by dissecting all avascular planes, and dividing the intestine.
Therefore, cadaver training should suffice in practicing this step.
Here, the second surgeon should be taught to pull the duodenum to the left side of the patient, and push the colon to the right caudal side of the patient to expose the dissection line see Figure 2. Exposing and clipping the vessels encountered during this phase is similar to that of smaller, less challenging procedures.
Make sure to have seen the approach of this step for aberrant vasculature, e. Therefore, training should focus on lymph node harvest, bleeding control, and transection of the gastroduodenal artery. The use of animal models for surgical training is quite common The porcine model has been validated for multiple laparoscopic procedures Perfusion of the vascular structures makes for an ideal setting to become familiar with bleeding control and vascular repair.
The porcine model is valuable in practicing this step to reach proficiency, yet falls short in practicing exposing the superior mesenteric vein. The anatomy of the porcine pancreas is such, that its pancreas covers the superior mesenteric vein for only small portion