Three trocars laparoscopic Whipple’s procedure with completely intracorporeal handsewn anastomoses—case report

Giovanni Dapri, Nigel Bascombe, Marco Montorsi


Whipple’s procedure has been described by open surgery, as well as by laparoscopy. In the last decade, reduced port laparoscopic surgery (RPLS) has been introduced in order to improve the cosmetic outcomes and to reduce the trocars’ complications. In this video, the authors report a full laparoscopic Whipple’s procedure, realizing the three anastomoses by intracorporeal handsewn technique using three trocars. A 57-year-old man presenting an adenocarcinoma of the pancreatic head, staged as cT1N0M0, underwent to a laparoscopic Whipple. Total operative time was 6 hours 46 minutes, and operative bleeding was 600 cc. Postoperative course was uneventful and the patient was discharged on 9th postoperative day. Pathologic report confirmed a well differentiated pancreaticobiliary adenocarcinoma, with perinervous infiltration and lymphovascular emboli, free margins, 0 metastatic lymph nodes on 24 isolated, and 8° UICC edition stage: pT1cN0. After 18 months, the patient is well and free of disease. Laparoscopic Whipple remains an advanced procedure to be performed by laparoscopy. Besides the other advantages of minimally invasive surgery, this technique can add for selected patients a reduced trocar’s morbidity and an improved patient’s comfort.