Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Laboratory of Anatomy, Faculty of Medicine and Pharmacy, University of Mons, Mons, Belgium.
Ann Surg Oncol. 2017 Sep;24(9):2785-2786. doi: 10.1245/s10434-017-5944-x. Epub 2017 Jun 26.
Whipple procedure has been described since 1935,1 using classic open surgery. With the advent of minimally invasive surgery (MIS), it has been described to be feasible using the latest technology.2 3 In this video the authors report a full laparoscopic Whipple procedure, realizing the three anastomoses by intracorporeal handsewn method.
A 70-year-old man who presented with adenocarcinoma of the ampulla of Vater, infiltrating the pancreatic parenchyma underwent to a laparoscopic Whipple. Preoperative work-up shows a T3N1M0 tumor.
No perioperative complications were registered. The pancreatico-jejunostomy was created in end-to-side fashion using two PDS 3/0 running sutures (Fig. 1), the hepatico-jejunostomy in end-to-side method using two PDS 4/0 running sutures (Fig. 2), and the gastro-jejunostomy in end-to-side method using two PDS 1 running sutures (Fig. 3). Total operative time was 8 h 20 min. Time for the dissection was 6 h 20 min, time for the specimen's extraction was 20 min, and time for the three laparoscopic intracorporeal handsewn anastomoses was 1 h 40 min. Operative bleeding was 350 cc. Patient was discharged on postoperative day 9. Pathologic report confirmed the moderately differentiated adenocarcinoma of the ampulla of Vater, with perinervous infiltration and lymphovascular emboli, free margins, 2 metastatic lymphnodes on 23 isolated; 8 edition UICC stade: pT3bN1.
Laparoscopic Whipple remains an advanced procedure to be performed by laparoscopy as well as by open surgery. All the advantages of MIS, such as reduced abdominal trauma, less postoperative pain, shorter hospital stay, improved patient's comfort, and enhanced cosmesis are offered using using laparoscopy.
自 1935 年 1 以来，已经描述了 Whipple 手术，使用经典的开放手术。随着微创外科（MIS）的出现，已经描述了使用最新技术进行可行的手术。2 3 在这个视频中，作者报告了一个完整的腹腔镜 Whipple 手术，通过腔内手工吻合方法实现了三个吻合。
一位 70 岁的男性，患有壶腹腺癌，浸润胰腺实质，接受了腹腔镜 Whipple 手术。术前检查显示 T3N1M0 肿瘤。
无围手术期并发症。胰肠吻合采用 2 根 PDS 3/0 连续缝线端端吻合（图 1），胆肠吻合采用 2 根 PDS 4/0 连续缝线端端吻合（图 2），胃肠吻合采用 2 根 PDS 1 连续缝线端端吻合（图 3）。总手术时间为 8 小时 20 分钟。解剖时间为 6 小时 20 分钟，标本取出时间为 20 分钟，三个腹腔镜腔内手工吻合时间为 1 小时 40 分钟。手术出血 350cc。患者术后第 9 天出院。病理报告证实为中度分化的壶腹腺癌，有神经周围浸润和脉管内栓塞，切缘无肿瘤，23 个孤立淋巴结中有 2 个转移淋巴结；第 8 版 UICC 分期：pT3bN1。
腹腔镜 Whipple 仍然是一种先进的手术，可以通过腹腔镜和开放手术进行。微创外科的所有优势，如减少腹部创伤、术后疼痛减轻、住院时间缩短、提高患者舒适度和增强美容效果，都可以通过腹腔镜来实现。
