Background : Laparoscopic pancreaticoduodenectomy(LPD) is attaining popularity in the high volume centers for the periamupllary tumors. But it is still technically demanding especially in understaffed, suburban medical centers. To overcome this limitations,we developed various retraction techniques to do safe LPD with minimum requirement of assistant. In this report, we share these retracting methods and postoperative outcomes after LPD

Methods : To obtain the continuous wide exposure along uncinate process, we applied external retractions at the pancreas neck stump and hepatic flexure colon in opposite directions. We reviewed the medical records of consecutive 18 patients who underwent LPD with this retracting methods by a single surgeon between September 2021 and July 2022. The perioperative outcomes were evaluated with comparisons of operation time, intraoperative bleeding, postoperative hospital stay, postoperative complications.

Results : The study subjects consisted of 13 males and 5 females, and the mean age was 67.33 years (range, 41–76 years). The mean intraoperative bleeding was 507.78 ± 329.69cc. The mean operation time was 528.05 ± 113.05 minutes. There was only one case of conversion to open due to tumor abutment to adjacent major vessels. There were 10 patients (55%) of postoperative complications which were mostly minors. Grade I postoperative pancreatic fistula(POPF) grade Biological leak(BL) 7 patients, and Grade I chyle leakage 1 patient. Grade II pulmonary thromboembolism(PTE) 1 patient and Grade IIIa of perihepatic fluid collection followed by percutaneous drainage 1 patient. The mean postoperative hospital stay was 11.44 ± 3.39 days. There were no postoperative deaths.

Conclusions : Except one case of open conversion, 17 cases of pure and safe LPD were performed using external retraction techniques. As most of the suburban hospitals struggle with lack of manpower, it is helpful for novice surgeons to use the external retraction methods to overcome the hurdles.