How To Make A Steady Transition To Total Laparoscopic Pancreaticoduodenectomy:A Single-Center Experience

Object:In recent years,with the replacement of endoscopic equipment and the rapid development of laparoscopic technology,laparoscopic pancreaticoduodenectomy has been gradually tried and popularized by major surgical treatment centers,and even this technology has become a recessive condition to evaluate the surgical strength of a diagnosis and treatment center.As a semi-minimally invasive surgical method,laparoscopy assisted pancreaticoduodenectomy can not only help the surgeon master the laparoscopic technique and increase experience in the process of learning LPD,but also ensure the safety and efficacy of surgery for beginners at this stage and avoid accidents to some extent.At present,there are many studies on the successful implementation of LPD,but few on the transitional effect of LAPD.Based on this,this study took LPD in the Huang Mingwen treatment group of the second affiliated hospital of nanchang university as an example,mainly for the purpose of Analyzed the safety feasibility of LPD,and summarized the experience of the steady development of LPD.Method:Collection in May 2012 to October 2019 in our hospital diagnosis of duodenal papilla carcinoma and conforms to the patients' clinical data included in the standard,and in the treatment group respectively,abdominal cavity mirror auxiliary line laparotomy and laparoscopic resection of pancreas duodenum,divided into an open pancreatoduodenectomy group(OPD group),a laparoscopy-assisted pancreatoduodenectomy group(LAPD group)and a laparoscopic pancreatoduodenectomy group(LPD group).through the comparison of three groups of patients with preoperative,intraoperative and postoperative indicators,assessment LAPD in carry out the transition function of LPD,and the technical experience of steadily promoting LPD was systematically summarized.Results:All patients successfully completed the operation,including 65 patients in the OPD group,20 patients in the LAPD group and 42 patients in the LPD group.The average time of operation was(213.57 ± 31.30)min in the OPD group,(262.50 ± 19.70)min in the LAPD group and(262.14 ± 25.86)min in the LPD group.There were significant differences between OPD group vs LAPD group(P=0.000)and OPD group vs LPD group(P=0.000).The average time of Specimen removal was(106.85 ± 16.17)min in the OPD group,(150.00 ± 17.47)min in the LAPD group,and(132.74 ± 16.50)min in the LPD group,There were significant differences between LAPD group vs LPD group(P=0.000).The intraoperative bleeding volume was(192.15 ± 101.76)ml in the OPD group,(161.50 ± 58.60)ml in the LAPD group,and(155.90 ± 53.17)ml in the LPD group.The number of lymph node dissection was(6.82 ± 5.41)in the OPD group,(7.50 ± 3.76)in the LAPD group and(7.90 ± 5.08)in the LPD group.In terms of postoperative recovery,the first time out of bed,the first feeding time and the postoperative hospital stay of the LAPD group and the LPD group were all shorter than those of the OPD group,and the differences were statistically significant.Complications occurred in 2 cases of LAPD group(10%)and 3 cases of LPD group(7.1%),both lower than that in 9 cases of OPD group(13.8%).Conclusion:LPD is a safe and feasible minimally invasive surgery.The steady transition to LPD requires multiple factors such as case screening,technical accumulation and team cooperation.In the process of learning LPD,LAPD can help beginners master the laparoscopic technique,shorten the operation time,and ensure the safety and efficacy of the operation.