Disclosure Statement of Financial Interest Franky Vansteenkiste MD “Nothing To Disclose”

Total laparoscopic pancreaticoduodenectomy – initial experience in a Belgian non-academic supraregional hospital F. Vansteenkiste MD, L. Kinget MD, M. D’Hondt MD Department of Digestive and HPB/Pancreatic Surgery Groeninge Hospital President Kennedylaan 4, 8500 Kortrijk Belgium

Material and methods A retrospective analysis of a prospective maintained database of our pancreaticoduodenectomies. We performed 45 pancreaticoduodenectomies between February 2012 and February 2016 9 were done open 34 were started laparoscopically, of those we had to convert to open surgery in 7 cases. Reasons for conversion were bleeding in 3 cases, unclear anatomy in 2 cases , periportal fibrosis in 1 case and tumor size in 1 case. We reviewed the clinicopathological data of our 27 total laparoscopic pancreaticoduodenectomy (TLPD) patients.

Results 27 TLPD Female /male : 13/14 Median age : 69.5 y (55-82) Median tumor size : 26 mm R0 resection is 26/27 patients Indication for TLPD

Results Operative data Median OR time : 335 min (240-420 min) Median blood loss : 100 cc (50- 1000cc) 24 PPPD – 3 classical Whipple procedures 17 duct to mucosa anastomosis – 10 dunking

Results Postoperative complications 10/27 had a pancreatic leak 4 type A, 5 type B , only 1 type C No life-threatening complications Only 5 dindo clavien type III Median hospital stay was 18 days (9-46) Dindo clavien

Conclusion TLPD seems feasable and safe to perform during initial learning curve by experienced hepatopancreatobiliary surgeons with advanced laparoscopic skills. Contact : Franky Vansteenkiste MD Department of Digestive and HPB/Pancreatic Surgery Groeninge Hospital President Kennedylaan 4, 8500 Kortrijk Belgium franky.vansteenkiste@azgroeninge.be