Background : Periampullary huge mass traditionally required open surgical approaches. However, the emergence of minimally invasive surgery techniques offers an alternative with potential benefits. This study focus on cases of a periampullary huge mass treated with minimally invasive pancreaticoduodenectomy, sharing surgical techniques by providing surgical video of the procedure.

Methods : The authors analyzed the preoperative and postoperative characteristics and pathological findings of 38 patients who underwent minimally invasive pancreaticoduodenectomy for periampullary huge mass that was diagnosed with imaging studies to be more than 4.5 cm in size from 2016 to 2023.

Results : In the analysis of a total of 38 patients, laparoscopic pancreaticoduodenectomy was performed in 19 cases, and robot-assisted surgery in 19 cases. Pylorus-preserving pancreaticoduodenectomy was carried out in 36 (94.7%) cases, while total pancreatectomy was performed in 2 (5.3%) cases. The average size of the tumors was 6.06±2.05 cm. The mean surgical duration was 450.39±84.97 minutes. The leading cause of pathologies leading to huge masses was Intraductal Papillary Mucinous Neoplasm (IPMN), accounting for 10 (26.3%) cases, Other pathologies included pancreatic ductal adenocarcinoma, neuroendocrine tumor, solid pseudo papillary neoplasm, among others. In the sub-analysis between laparoscopic and robot-assisted surgeries, there were no significant differences in patient characteristics, surgical duration, intraoperative blood loss, tumor size, pathological findings, and other factors.

Conclusions : The surgical treatment of periampullary huge mass has traditionally been open surgery, which involves a large incision in the abdomen. However, minimally invasive pancreaticoduodenectomy can also be performed as a treatment for such huge masses, serving as an alternative to open surgery.