Huge cystic lesions compressing the mesenteric vessels, which were identified in 3 patients as intraductal papillary mucinous neoplasm, were not excluded because they had no findings of invasive extension. One patient had undergone distal gastrectomy previously. Preoperative diagnosis was intraductal papillary mucinous neoplasm in 12 patients, ampullary carcinoma in 6 patients, early-stage pancreatic carcinoma in 5 patients, and metastatic carcinoma http://www.selleckchem.com/mTOR.html of renal-cell carcinoma,

neuroendocrine tumor of the bile duct, and duodenal carcinoma in 1 patient, respectively. Mean overall operative time of 26 patients was 519 minutes (range 349 to 778 minutes), with mean blood loss of 322 g (range 10 to 1,520 g). Mean time for resection, which means the time from insertion of the first trocar until removal of the specimen, was 263 minutes

(range 169 to 522 minutes). Conversion during resection was required in 2 patients. The reasons for conversion were the need to resect and reconstruct PV and difficulty controlling hemorrhage from the hole of the back of the SMV. Intraoperative blood transfusion was not required in any patients. Postoperative complications occurred in 13 patients. Postoperative pancreatic fistula of grades A, B, and C6 occurred in 2, 3, and 1 patients, respectively, and delayed gastric emptying in 3 patients and peptic ulcer, congestion of the brought limb of the jejunum, abdominal abscess, portal vein thrombus and pneumonitis occurred in 1 patient, respectively. learn more Except for PAK6 postoperative hemorrhage in a patient with postoperative pancreatic fistula grade C who required radiological intervention, complications were resolved with conservative measures. Post-treatment course of the patient with postoperative pancreatic fistula grade C was

good. Mortality was zero. Even via the open approach, most surgeons are probably stressed during dissection of the pancreas from the mesenteric vessels due to difficulty with bleeding control and making a precise dissection line. This appears to be one of the reasons why laparoscopic PD has yet to be accepted as a generalized surgical method. However, in practice, because the unique laparoscopic view from the caudal side provides a magnified and closely caudal-back view of the pancreatic head, the anatomy around the uncinate process, especially the relation to the nerve plexus and the mesenteric vessels, is made easier for prehension, so that more meticulous surgery can be performed via the laparoscopic approach than in open surgery. In addition, the current procedure of peeling the pancreas from the uncinate process first without early dissection of the pancreatic neck has several advantages.