Laparoscopic pancreatoduodenectomy: our clinical experience in a tertiary hospital in Indonesia

Background: Pancreatoduodenectomy (PD) is one of the most complex abdominal surgery procedures. Laparoscopic PD (LPD) has spread rapidly over the last decade due to the new development of laparoscopic devices and a better understanding of anatomy. The LPD offers reduced blood loss, less postoperative pain, shorter hospital stays, and minimal operative scars compared to Open PD (OPD). However, the LPD has a steep learning curve. In this article, we reported our cases of LPD in our hospital in Indonesia. We hope this report will support the development of advanced laparoscopic surgery in Indonesia. Methods: We took data from medical records of patients who underwent LPD from 2017 to 2023. We collect demographic information, surgery duration, intraoperative blood loss, pathologic report, pancreatic fistula, and postoperative length of stay (LOS). We divided the data into two groups and compared our data before and after forming the team for LPD surgery. The ethical approval was obtained from the hospital review board. Results: We analyzed 22 LPDs from 2017-2023. There were 12 LPDs performed in 2019-2020 by non-team setting and 10 LPDs performed in 2022-2023 by the team. Fourteen patients were males, and eight were females, with the mean age being 50 years. There was an improvement in intraoperative blood loss and duration of surgery after we formed the team. There were three postoperative pancreatic fistulas (POPF) and three mortalities. The mean postoperative LOS was 20 days from seven and 10 days from nine cases before and after team formation. Conclusion: The high-volume center and the team protocol help surgeons effectively overcome the steep learning curve of LPD.