Introduction: Laparoscopic pancreaticoduodenectomy for cancer is still controversial, especially as regards to the difficulty and duration of the procedure. The oncological adequacy is strongly questioned.

Methods: The video show-casts a totally laparoscopic pancreaticoduodenectomy (Whipple), with extensive en-bloc lymphadenectomy and high vessel ligation, for ductal adenocarcinoma of the head of the pancreas, C25.0, cT2N0, in a 65 year old, white female. The technical steps are outlined and detailed with enhanced visualization, thanks to the magnification of the endoscope. A thorough, oncologically adequate resection is demonstrated step-wise. The video does not include the reconstruction and anastomoses.

Results: The procedure went uneventful and took 4 hours and 35 minutes. The patient did well and left hospital on day 12. Resection margins were negative (R0), and a total of 35 nodes were harvested. The pathological results showed a more advanced lesion than assessed at preoperative work-out, the tumor being pT2N1Mx(0). The patient was put on adjuvant chemotherapy on day 21, receiving a regimen of 5FU and gemcitabine.

Conclusion: Laparoscopic pancreaticoduodenectomy for cancer, though technically demanding, might help improve prognosis of pancreatic cancer by the very quality of the oncological resection and by faster delivery to adjuvant treatment, due to shorter recovery times. Additionally, laparoscopy proves a fantastic educational tool, for both anatomy and surgery.