Pancreas-hanging maneuver in laparoscopic pancreaticoduodenectomy: a new technique for the safe resection of the pancreas head

Laparoscopic pancreaticoduodenectomy (PD) is challenging, and the performance of successful laparoscopic PD has been limited. The dissection of the pancreatic head from the right aspect of the portal vein and the superior mesenteric artery is one of the most difficult procedures in laparoscopic PD. For the safe dissection of the pancreatic head during laparoscopic PD, we developed a novel "pancreas-hanging maneuver" technique. Nine patients underwent this new surgical procedure between December 2008 and June 2009 during the course of laparoscopic pylorus-preserving PD. The pancreas-hanging maneuver can ensure suitable tension, surgical field, and laparoscopic view for the resection of the pancreatic head during PD. Mean intraoperative blood loss was 642 ml (range = 420-780 ml). This new surgical procedure can provide good tension and an appropriate laparoscopic view with a suitable surgical field for safely dissecting the pancreas head from the major mesenteric vessels during laparoscopic PD.