Strategy and technique of pancreatojejunostomy in minimally invasive pancreaticoduodenectomy: clinical practice review

Abstract

: With the spread of minimally invasive surgeries such as laparoscopic or robotic surgeries, they are increasingly being used for pancreaticoduodenectomy (PD) as well, however pancreaticojejunum (PJ) anastomosis is quite challenging to perform in a minimally invasive surgery. We need to know more about methods in minimally invasive surgery PJ anastomosis. In this clinical practice review article, we present several papers about the technical aspects of PJ anastomosis in on laparoscopic and robotic PD, including a comparison of their surgical results, as well as initial results from our institution. There were more papers on laparoscopic PJ anastomosis than robotic PJ anastomosis. Some reports have shown that robotic surgery has a better outcome, and our institution's results showed that robotic surgery significantly outperformed in terms of blood loss and length of hospital stay. This article summarizes the technical methods and comparative results of Laparoscopic and robotic PD, especially in PJ anastomosis. The results of the PJ anastomosis in robotic pancreaticoduodenectomy (RPD) were seemed not inferior to those of the laparoscopic pancreaticoduodenectomy (LPD) in the past literature at least with respect to safety, and were superior than that of LPD in the results of our department. However, randomised controlled trial (RCT) is needed to clarify the true comparison between the results of LPD and RPD.