Laparoscopic Pancreaticojejunostomy Anastamosis Using an Articulating Needle Holder.

Background: Pancreaticojejunal anastomosis is a technically challenging stage of the pancreaticoduodenectomy procedure for even the most experienced surgeon. We illustrate a buttressed duct-to-mucosa anastomosis (modified Blumgart technique) during laparoscopic pancreaticoduodenectomy using an articulating needle holder (FlexDex) (Video, Supplemental Digital Content 1, http://links.lww.com/SLE/A299).

Methods: While performing a minimally invasive pancreaticoduodenectomy, an articulating needle holder (FlexDex) is introduced through an 8 mm laparoscopic port and used to perform the duct-to-mucosa pancreaticojejunal anastomosis. Parenchymal buttressing using 3/0 double ended barbed suture (Stratafix) and pancreas duct to jejunum using 5/0 Prolene.Approval was obtained from the Office of Ethics and Research Governance at our institution. Consent was gained from the individual patient involved, to submit this intraoperative video for publication.

Results: Successful intraoperative pancreaticojejunal anastomosis was performed using the articulating needle holder (FlexDex). The patient recovered from the procedure without complication, with no postoperative pancreatic fistula.

Conclusions: We demonstrate the feasibility of performing a laparoscopic pancreaticojejunal anastomosis using an articulating needle holder (FlexDex).