Full Lapaproscopic Pancreaticoduodenectomy. Description of the Technique

The feasibility of safely fully laparoscopic CDP has been demonstrated by several authors. For its realization, we propose a 5 trocars approach. Kocher maneuver is performed to reach the inferior vena cava, the infrarenal aorta, the rear plate of the uncinate process and the superior mesenteric artery. Lymphadenectomy in the region can be done in a comprehensive way; interaortico cave, around the hepatico-duodenal ligament and the celiac trunk and its branches. After dissection of the portal vein (PV), the pancreas can be cut away from the tumor, and its right part separated from the PV. The duodenal bulb and the first jejunal loop are cut using a linear stapler. After cholecystectomy, the bile duct is cut upstream of the cystic. The reconstruction will include three anastomoses: termino-lateral posterior pancreatogastric by "telescoping", end-to-side duodeno-jejunal and end-to-side hepatico-jejunal.