Short Run of the Hybrid Whipple–Smooth Sailing or Rough Waters?

Background: Open pancreaticoduodenectomy, the gold standard for periampullary cancer is associated with significant morbidity.As minimally invasive surgery gains its ground in oncology, conflicting evidence regarding the technically challenging minimally invasive Whipple continues to challenge surgeons across the world.Methods: A total of 10 patients with periampullary cancer underwent hybrid Whipple (Robotic/laparoscopic resection and Open Reconstruction) procedure at Kidwai Memorial Institute of Oncology between January 2023-September 2024 and demographic, staging, performance scores, and intraoperative and postoperative outcomes were recorded and analyzed.Results: Mean operative time was 337 minutes and mean intraoperative blood loss was 625 ml.The rate of conversion was 2/10 (1 emergent, 1 non-emergent).The mean lymph nodal harvest was 7.3 lymph nodes and the range was 4-12 lymph nodes.50 % of patients developed grade A postoperative pancreatic fistula and all were managed conservatively.The extent of resection was R0 in all patients.Median length of hospital stay was 20 days. Conclusion:In our experience, hybrid Whipple surgery is a safe and feasible option for carefully selected patients with periampullary carcinoma.We completed resection in 80% of cases with comparable blood loss.Open reconstruction preserved tactile feedback, aiding high-quality anastomoses.Final histopathology confirmed margin negativity and adequate lymph node yield, supporting oncological safety.Despite a steep learning curve, hybrid Whipple offers advantages like magnification, reduced length of hospital stay, and less blood loss, without increasing major complications.Our experience at a tertiary care academic center affirms its potential as a valuable surgical approach.