There is a small number of centres around the world were minimally invasive techniques are offered routinely for cancer located in head of pancreas.The initial report of laparoscopic pancreaticoduodenectomy was by Michael Gagner in 1994. Number of techniques in minimally invasive surgery for pancreatic head had been reported and include totally laparoscopic Whipples, hand assisted laparoscopic whipples resection, laparoscopic resection combined with minilaparotomy to achieve reconstruction.What make this operation laparosocpically demanding is the location of head of pancreas in close relation to superior mesentric artery and vein and the demand to reconstruct the continuity of pancreas,bilie duct and stomach .The resection involves resection of distal stomach,CBD, head of pancreas and proximal jejunum.The continuity for the bile duct and pancreas has to be hands sewn as, to date no staplers are there to achieve this anastomosis. We present a case report of patient who underwent the first totally laparoscopic whipples resection at MIMS hospital (First time done in Malabar)
72 year old female patient reported to OPD with features of obstructive jaundice.She was evaluated and diagnosed to have periampullary malignancy by side viewing endoscopy and biopsy.CECT did not show any dissemination of malignancy.She underwent total laparoscopic Whipples resection(pylorus preserving pancreaticoduodenectomy ) and her post op period was uneventful .She had a hospital stay of around 7 days.
The case has been presented to highlight that even pancreatic head resections could be done laparoscopically without compromising oncological safety and also give the advantages of laparoscopic surgery like less pain,improved cosmesis,early recovery and minimal stay in the hospital.
Fig1. Reconstruction in Whipples (pylorus preserving pancreaticoduodenectomy),pancreatojejunostomy, hepaticojejunostomy and duodenojejunosotmy in that order.
Fig 2 pancreatic neck dissection over the portal vein
Fig 3. Uncinate dissection inpancreaticoduodenectomy
Fig 4 laparosocpic pancreaticojejunal (duct to mucosa)anastomosis
Dr. Sajeesh Sahadevan MS, MCh
Consultant – Gastro intestinal Surgeon