PT  - JOURNAL ARTICLE
AU  - Yifan Wang
AU  - Simon Bergman
AU  - Sabrina Piedimonte
AU  - Tsafrir Vanounou
TI  - Bridging the gap between open and minimally invasive pancreaticoduodenectomy: the hybrid approach
AID  - 10.1503/cjs.026713
DP  - 2014 Aug 01
TA  - Canadian Journal of Surgery
PG  - 263--270
VI  - 57
IP  - 4
4099  - http://canjsurg.ca/content/57/4/263.short
4100  - http://canjsurg.ca/content/57/4/263.full
SO  - CAN J SURG2014 Aug 01; 57
AB  - Background: Minimally invasive pancreatic surgery has evolved rapidly, but total laparoscopic pancreaticoduodenectomy has not been widely adopted owing to its technical complexity. Hybrid laparoscopy-assisted pancreaticoduodenectomy (HLAPD) combines the relative ease of open surgery with the benefits of a minimally invasive approach. This study evaluates the safety and effectiveness of the hybrid approach compared with open surgery.Methods: We retrospectively analyzed data of consecutive patients undergoing either hybrid or open pancreaticoduodenectomy (OPD) at our institution between September 2009 and December 2013. Demographic, operative and oncologic data were collected to compare outcomes between HLAPD and OPD.Results: Our analysis included 33 patients (HLAPD: n = 13; OPD: n = 20). There were no differences in patient demographics, comorbidities or surgical indications. The HLAPD group had significantly lower intraoperative blood loss (450 mL v. 1000 mL, p = 0.023) and shorter length of hospital stay (8 v. 12 d, p = 0.025) than the OPD group. Duration of surgery did not differ significantly between the groups. There were no differences in postoperative analgesic requirements, Clavien grade I/II or grade III/IV complications or 90-day mortality. Oncologic outcomes showed no significant differences in tumour size, R1 resection rate or number of lymph nodes harvested.Conclusion: In select patients, HLAPD is a safe and effective procedure with comparable outcomes to conventional open surgery. Wider adoption of the hybrid approach will allow a greater number of patients to benefit from a less invasive procedure while facilitating the transition toward purely minimally invasive pancreaticoduodenectomy.