This video-presentation demonstrates the surgical steps during a laparoscopic pancreaticoduodenectomy. The anatomy is well identified and the key surgical steps are emphasized. The reconstruction included an end to side choledocho-jejunostomy, an end to side pancreatico-jejunostomy with a duct to mucosa anastomosis, as well as a Roux-en-Y Gastro-jejunostomy.

The patient is an 81 year old male that presented with a several month history of episodic right upper quadrant pain and nausea. Work-up uncovered a markedly elevated Lipase to 12,138 U/L and an Amylase of 162 U/L. An ultrasound of the abdomen reported the presence of cholelithiasis as well as a dilated pancreatic duct. A CT scan of the abdomen demonstrated the presence of a pancreatic head cystic mass consistent with an intraductal papillary mucinous neoplasia (IPMN). An ERCP x 2 was unable to cannulate the ducts. Because of the presence of significant co-morbidity as well as his age, the patient chose to proceed with a laparoscopic cholecystectomy and re-assess the pancreatic lesion according to progress. Subsequent follow-up CT scans at nine months, demonstrated an enlargement of the pancreatic head mass with worsening involvement of the uncinate process. After undergoing a laparoscopic pancreaticoduodenectomy, the patient recovered uneventfully. He was started on oral intake on POD#4 and discharged from the hospital on POD#8. Pathology reported the presence of an intraductal papillary mucinous carcinoma with focal microscopic invasion. All resection margins and 12 lymph nodes were free of malignancy. He returned to normal activities without compromise of his quality of life and at the time of submission of this abstract, he is alive without evidence of disease at 11 months after surgery.