Duodenopancreatectomía totalmente laparoscópica: Consideraciones técnicas y aplicabilidad inicial en un centro de alto volumen de cirugía pancreática

background: pancreatoduodenectomy is the treatment of choice for periampullary tumors. the first laparoscopic whipple was performed by gagner in 1994. however, the extensión of the dissection, the need to perform múltiple anastomoses in reconstructive phase and the length of the procedure were the main reasons that discouraged surgeons. however in recent years the laparoscopic whipple procedure has emerged as a therapeutic alternative with encouraging results in selected patients. aim: present the initial experience with laparoscopic whipple procedure and the technical aspeets of the approach. setting: hepatobiliopancreatic surgery sector of the hospital italiano de buenos aires. design: prospective, observational. population: 28 patients undergoing whipple procedure between december 2010 and june 2011, eight ofthem were addressed by laparoscopy and they are the group that we analyzed. method: we analyzed patients approached laparoscopically with intent resection. operative time, intra and postoperative complications, length of stay, conversión rate, applicability of the approach and the mortality rate of laparoscopic and global pancreatoduodenectomy were the variables that we analyzed. results: mean operative time was 470 minutes. the conversión rate to open surgery was 25%, and the applicability of the approach was 28%. there were 33% major complications. the average length of stay was 8 days. conclusions: laparoscopic whipple procedure ？san alternative laparoscopic technique feasible in selected patients carry periampullary tumors, the initial selection of patients has led to a population of more easily resectable disease, but more difficult to rebuild.