Pancreatoduodenectomy using a no-touch isolation technique

Hirota, Masahiko; Kanemitsu, Keiichiro; Takamori, Hiroshi; Chikamoto, Akira; Tanaka, Hiroshi; Sugita, Hiroki; Sand, Juhani; Nordback, Isto; Baba, Hideo

doi:10.1016/j.amjsurg.2008.06.035

« PreviousThe American Journal of Surgery
Volume 199, Issue 5 , Pages e65-e68, May 2010

Pancreatoduodenectomy using a no-touch isolation technique

Masahiko Hirota, M.D.
- Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Kumamoto City, Kumamoto 860–0811, Japan
- Corresponding author. Tel.: +81-96-363-3311; fax: +81-96-362-0222
Keiichiro Kanemitsu, M.D.
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto City, Japan
Hiroshi Takamori, M.D.
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan
Akira Chikamoto, M.D.
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan
Hiroshi Tanaka, M.D.
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan
Hiroki Sugita, M.D.
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan
Juhani Sand, M.D.
- Division of Surgery, Gastroenterology and Oncology, Tampere University, Tampere, Finland
Isto Nordback, M.D.
- Division of Surgery, Gastroenterology and Oncology, Tampere University, Tampere, Finland
Hideo Baba, M.D.
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto City, Japan

Received 6 May 2008; received in revised form 3 June 2008 published online 19 December 2008.

Abstract

Background

Pancreatoduodenectomy is the only effective treatment for cancers of the periampullary region. Because surgeons usually grasp tumors during pancreatoduodenectomy, this procedure may increase the risk of squeezing and shedding the cancer cells into the portal vein, retroperitoneum, and/or peritoneal cavity. In an effort to overcome these problems, we have developed a surgical technique for no-touch pancreatoduodenectomy.

Methods

From March 2005 through May 2008, 42 patients have been operated on following this technique. Resected margins were microscopically analyzed.

Results

We describe a technique for pancreatoduodenectomy using a no-touch isolation technique. We resect cancers with wrapping them within Gerota's fascia and transect the retroperitoneal margin along the right surface of the superior mesenteric artery and abdominal aorta without grasping tumors.