Is mini-invasive pancreaticoduodenectomy a niche surgery?

Mini-invasive approach has become the standard for many abdominal procedures such as cholecystectomy, colectomy, liver resection, etc. Can we say that Mini-invasive pancreaticoduodenectomy (MIPD) should be considered the standard of care and that open pancreaticoduodenectomy (OPD) should be limited to selected cases? Not yet. There still be a lack of convincing, high-quality data showing transformative benefit in clinical outcomes or cost as seen with other surgical procedures previously performed exclusively by open approach. However, several publications from all around the world suggest subtle benefit over OPD, when the procedure is performed in experts Centers. The scientific evidence underlines that to perform MIPD safely and with better results than OPD: hospital volume, surgeon volume, specific training, and long learning curve matters. We need to accept that even if we can hear in congress that «MIPD is here to stay» it should be and it will be performed by a limited number of specialized surgeon.

In this number of Laparoscopic Surgery several experts discuss some of hottest topics in the field of MIPD.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Laparoscopic Surgery for the series “Mini-invasive pancreaticoduodenectomy: are we moving from a “feasible” intervention to be considered the standard?”. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/ls.2020.03.03). The series “Mini-invasive pancreaticoduodenectomy: are we moving from a “feasible” intervention to be considered the standard?” was commissioned by the editorial office without any funding or sponsorship. ER served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Laparoscopic Surgery from Oct 2019 to Sep 2021. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and re-solved.

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Edoardo Rosso