Major venous resection during total laparoscopic pancreaticoduodenectomy

Background: The feasibility of total laparoscopic pancreaticoduodenectomy (TLPD) has been established. Laparoscopic major venous resection during TLPD has not been reported. The aim of the present study was to describe the technique and outcomes of patients undergoing TLPD with major venous resection. Methods: Retrospective review of all consecutive patients undergoing TLPD and major venous resection from July 2007 to December 2010 was performed. Patient demographics and peri-operative outcomes were retrieved. Data are presented as mean ± standard deviation (SD) or median with range. Results: Out of 129 patients undergoing TLPD, major venous resection was performed in 11 patients with a mean age of 71 years. Median operative time and blood loss was 413 (301-666) min and 500 (75-2800) ml, respectively. Venous resection included tangential (n= 10) and segmental resection (n= 1). Venous reconstruction included patch (n= 4), suture (n= 4), stapled (n= 2) and a left renal vein interposition graft (n= 1). Median mesoportal clamp time was 35 (10-82) min. There was no 30-day or in-hospital mortality. Post-operative imaging was available in 10 patients with 100% patency at the venous reconstruction site. Conclusions: Laparoscopic major venous resection during TLPD is feasible in selected patients. Extensive experience with complex laparoscopic pancreatic resection and reconstruction is advocated before attempting this procedure.