Total laparoscopic pancreaticoduodenectomy and reconstruction for a cholangiocarcinoma of the bile duct

Background: In this paper, we report on our experience with a totally laparoscopic pancreaticoduodenectomy performed for a cholangiocarcinoma of the lower third of the bile duct. Methods: The patient was placed in the steep reverse Trendelenberg, Lloyd-Davis position. The procedure was performed with six laparoscopic ports, using similar steps to the open approach, with the use of an ultrasonic cutting and coagulating instrument for dissection and endoscopic linear stapling devices for the bile duct, intestinal, and gastroduodenal artery division. Reconstruction was done on a single loop by an intracorporeally sutured pancreaticojejunostomy, hepaticojejunostomy, and a stapled gastroenterostomy. The resection specimen was placed in a bag and retrieved through a 5-cm Pfannenstiel incision. Results: Histology confirmed a T3 N1 R0 cholangiocarcinoma with the involvement of 1 of 17 lymph nodes. Twelve months following surgery, he remains well, having completed a course of adjuvant chemotherapy. Conclusions: Although the operation was technically demanding, it can be safely performed with a good oncologic result.