Hybrid laparoscopic pancreaticoduodenectomy: an Australian experience and a proposed process for implementation.
BACKGROUND
Laparoscopic pancreaticoduodenectomy (LPD) is gaining interest with several series reporting favourable outcomes. However, there are significant limitations to the successful implementation of LPD programmes in Australian and New Zealand (ANZ) settings. This study presents a local series of consecutive hybrid LPD (HLPD) and a suggested protocol for implementation of an LPD programme in ANZ settings.


METHODS
A retrospective review of consecutive patients undergoing HLPD with a laparoscopic resection and open reconstruction performed by a single surgeon at two centres in Sydney, Australia, between February 2014 and October 2019 was undertaken. Data were collected from a prospectively maintained database and patient records.


RESULTS
Eighteen patients underwent HLPD. Median operative time was 370 min, with a median laparoscopic resection time of 253 min. Median length of stay was 11 days. There was no mortality within 90 days. Post-operative complications included two patients requiring a return to operating theatre for post-operative pancreatic fistula, and five patients with delayed gastric emptying. Median number of lymph nodes harvested was 13 (interquartile range 11-15.8). Resection margins were negative in 15 patients (83.3%).


CONCLUSION
HLPD is associated with satisfactory perioperative outcomes and may be feasible as a first step towards eventual implementation of LPD in ANZ hospitals.
['Pham|Helen|H|0000-0001-6851-4030', 'Nahm|Christopher B|CB|', 'Hollands|Michael|M|', 'Pang|Tony|T|', 'Johnston|Emma|E|', 'Pleass|Henry|H|', 'Richardson|Arthur|A|', 'Lam|Vincent|V|', 'Yuen|Lawrence|L|']
D001315:Australia D006801:Humans D010535:Laparoscopy D007902:Length of Stay D061646:Operative Time D010180:Pancreatectomy D010190:Pancreatic Neoplasms D016577:Pancreaticoduodenectomy D011183:Postoperative Complications D012189:Retrospective Studies
pancreaticoduodenectomy hepatopancreaticobiliary surgery minimally invasive