3D Laparoscopy-Assisted Procedure of Duodenum, Common Bile Duct, and Oddi's Sphincter Preserving Pancreatic Head Total Resection

Summary

Here, we present a protocol to provide an ideal minimally invasive surgical approach for the pancreatic head in treating benign, borderline, and low-grade malignant pancreatic tumors as well as chronic pancreatitis.

Abstract

Surgical intervention has demonstrated established efficacy for benign, borderline, and low-grade malignant tumors of the pancreatic head, as well as for chronic pancreatitis. While conventional surgical approaches are associated with significant trauma and considerable loss of digestive function, the current focus in managing these conditions has shifted toward preserving functional organs through minimally invasive techniques. Through an in-depth understanding of the peripancreatic vascular arches, our team has modified the classic Beger procedure to achieve complete en bloc resection of pancreatic head tissue. By leveraging 3D laparoscopic technology, we have successfully integrated the advantages of minimal invasiveness and precise resection. This refined technique preserves duodenal and biliary integrity while ensuring complete removal of pancreatic head tissue, effectively reducing surgical complications, minimizing operative trauma, and decreasing postoperative gastrointestinal dysfunction. Consequently, patient outcomes are substantially improved. This article aims to elucidate the key technical details of this procedure, enabling more surgeons to master and enhance its success rate, thereby providing better treatment options for eligible patients.

Introduction

Chronic pancreatitis (CP) and benign, borderline, or low-grade malignant tumors of the pancreatic head often impose significant suffering and health risks on patients¹. Surgical intervention plays a crucial role in the comprehensive management of chronic pancreatitis and pancreatic head tumors of these types^2,3,4. Its objectives include pain relief, improvement of pancreatic function, management of complications, and curative resection of tumors, representing the most effective treatment strategy currently available⁵.

Protocol

This surgical approach has received approval from the Ethics Committee of Chongqing General Hospital, Chongqing University. All patients undergoing this procedure provided written informed consent.

1. Exclusion and inclusion criteria

1. Include patients with benign tumors: e.g., serous cystadenoma, mucinous cystadenoma, solid pseudopapillary neoplasm (SPN), low-grade malignant tumors: e.g., neuroendocrine tumors (NETs G1/G2), intraductal papillary mucinous neoplasms (IPMNs) without invasive components¹², Pancreatic head ductal calculi and chronic pancreatitis, and anatomical anomalies: e.g.,....

Results

Between December 2023 and April 2025, our surgical team performed 3D laparoscopy-assisted DCOPPHTR on 8 patients. All cases involved benign or low-grade malignant tumors. Two patients had postoperative follow-up durations of less than 3 months, while the remaining 6 patients were followed for over 3 months. The baseline characteristics of these 6 patients are presented in Table 1. The cohort included pancreatic NETs, SPNs, and IPMNs.

All patients successfully underwent the pro.......

Discussion

The cornerstone of this procedure's success is the preservation of the pancreaticoduodenal vascular arcades. Compromise of these arcades can lead to duodenal or CBD ischemia, potentially resulting in severe complications such as duodenal or biliary necrosis, major bile leak, infection, or hemorrhage. While preservation of both anterior and posterior arcades is ideal, it can be technically challenging with large tumors or severe peripancreatic inflammation. A team from West China Hospital noted that anatomical variati.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
4K-3D NIR/ICG Videoendoscope	KARL STORZ	OTV-S400	Imaging System
Endoscopic Camera Equipment	KARL STORZ	TC304	Image 1 S 4U-Link High-Definition Connection Main Unit Module
Endoscopic Surgical Instruments	Aesculap AG	20162223321	Endoscopic Surgical Instruments
Esomeprazole Sodium for Injection	AstraZeneca PLC	86979096001287	Proton Pump Inhibitor
Ethicon Endo-Surgery Generator	Johnson & Johnson	20153230137	Provide ultrasound and radiofrequency energy
HARMONIC Ultrasonic Scalpel	Johnson & Johnson	HAR1120	Ultrasonic Energy Cutting
HEM-O-LOK Polymer Ligating Clips	WECK	544230 Medium-Large	Locking ligation system.
LED Cold Light Source for Endoscope	KARL STORZ	TL400	Main Unit of Medical Endoscope Cold Light Source
Piperacillin Sodium and Tazobactam Sodium for Injection	Wyeth Piperacillin Div. of Wyeth Holdings Corporation	J20110021	Broad-spectrum antibiotics
Pleated Drainage Tube	Sumitomo Bakelite Akita Co., Ltd	MD-45110	Surgical Site Drainage
Polydioxanone Suture	Ethicon	29943	Soft Tissue Suture
Somatostatin for Injection	Merck Serono SA Aubonne Branch	8.69793E+13	Synthetic Somatostatin Analogues