Laparoscopic bilio-enteric Roux-en-Y gastrojejunostomy for unresectable pancreatic cancer

This video demonstrates the laparoscopic approach of a cephalic
duodenopancreatectomy in a 70-year-old patient presenting with an
adenocarcinoma of the pancreatic head. Using 4 ports, the duodenum is completely detached. The unciform process is prepared posteriorly by dissecting the superior mesenteric artery and the portal vein in its right lower section. A total lymph node resection and an antrectomy have been performed, followed by the resection of the pancreatic body. Last but not least, the small bowel is divided and the duodenum is de-crossed. The dissection shows the different steps of the procedure with extra details.

This film demonstrates the laparoscopic resection of a pancreatic tumor in a 47-year-old woman who consulted for epigastric pain. The preoperative exam showed a tumor larger than 4cm situated at the body of the pancreas.

The solid pseudopapillary tumor of the pancreas, also known as Frantz’s tumor, is an uncommon occurrence usually seen in younger women. It is usually of low grade malignity and most patients have no recurrence after successful surgical resection.
In the last few years, laparoscopic approach to resection procedures for benign pathologies or low-grade malignancies of the pancreas has been increasingly used. The traditional surgical approach to the distal pancreas requires large abdominal incisions because of the deep position of the gland, and entails possible postoperative complications such as wound infections and incisional hernia.
In this video, we present a laparoscopic distal pancreatectomy with splenectomy for a localized tumor of the tail of the pancreas. It shows some steps, which could simplify the technique and prevent some complications as bleeding or postoperative fistula.

This is the case of a 76-year-old female patient who was referred to our hospital because of intraductal papillary mucinous neoplasm (IPMN). The patient has a medical history of renal insufficiency, sleep apnea syndrome, type 2 diabetes mellitus (T2DM), and hypertension. She has also a history of previous total hysterectomy.
MRI findings showed that the patient’s IPMN affected secondary pancreatic ducts entirely.
The main pancreatic duct is dilated, especially in the distal part at 6mm, but there are no remarkable findings of cystic wall thickening or intracystic nodules. A laparoscopic distal pancreatectomy was planned.
The postoperative course was uneventful and the patient was discharged on postoperative day 8.
Pathological findings showed that the intraductal papillary mucinous neoplasm was without any malignant component.