Introduction : The purpose of this study is to analyze our initial experience with laparoscopic duodenopancreatic resection. Laparoscopic pancreatoduodenectomy is advocated to improved perioperative outcomes, including decreased blood loss, shorter length of stay, reduced postoperative pain and expedited time to functional recovery. However, the indication to minimally invasive approach for pancreatic surgery is often benign or low grade malignances.

Methods : The steps of LDP procedures are similar to the open procedure. We perform destructive part of procedure totally laparoscopically and we prefer to do reconstructive part of procedure using hand-assisted techniques. For the period 2014-2018, we have been perform 96 PD, 28(29%) we have done with laparoscopic approach. 6(6,2%) of patients were operated totally laparoscopic and 22(22%) of patients were operated by hand-assisted techniques.

Results : We found longer operative time in laparoscopic group, 385min. vs 210 min in open group. Mean blood loss was 260ml in laparoscopic operated patients and 430 ml in open group. Mean length of stay was 8 days in laparoscopic group vs 14 days in open group. Overall morbidity in laparoscopic group was 19%. One patient with superior vein thrombosis(Clavien-Dindo-II), One patient with postoperative acute necrotizing pancreatitis(Clavien-Dindo-IVa), a 2(two) patient with low debit pancreatic fistula(Clavien-Dindo-II). Mortality rate was 7%(1 patient was died in early postoperative period from venous mesenterial thrombosis and multiorgan dysfunction.

Conclusions : LPD can be done laparoscopically in selected patients by experienced surgeons ( in laparoscopic and open surgery too), but clear advantages remain to be defined