Minimally invasive pancreaticoduodenectomy is the most complex pancreatic surgery; a laparoscopic or robotic approach are both possible. The main indication consists of tumours of the head of the pancreas.
The intervention consists of two main parts: 1) resection, and 2) reconstruction. During the resection stage the pancreatic head tumour is removed en bloc with the distal part of the stomach, the duodenum, the head of the pancreas, the biliary tract, gall bladder and lymph nodes of the area affected by the tumour; in some selected cases it is also necessary to resect a segment of the portal or of the mesenteric vein (vascular resection). In the reconstruction stage the continuity of the biliary, stomach and pancreatic tract is restored; many technical variants of the reconstruction approach are possible.
The surgery is long (several hours) and is often technically complex, but the approach is now well standardised.
Postoperative complications, even in expert or super-experienced hands, are frequent: > 30%; complete rehabilitation of the patient is gradual.
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