The pancreas has long been an organ that has defied surgical intervention. Walter Kausch (22) is credited for performance of the first pancreaticoduodenal resection, reported in 1912. The lead of Allan O. Whipple in the late 1930s, however, provided major impetus for surgeons to continue efforts at pancreatic resection, and his name remains synonymous with pancreaticoduodenectomy. In the 50 years following Whipple's landmark work, pancreatic surgery was plagued by extremely high morbidity, and mortality approaching 25%. These results combined with poor long-term survival from pancreatic cancer led some prominent American surgeons to call for a moratorium on pancreaticoduodenectomy as recently as the 1970s (23). Around this time, reports of two series of pancreaticoduodenectomy performed without operative mortality encouraged surgeons to persist, and the past 3 decades have realized remarkable advances in pancreatic surgery (24,25). Pancreatic resection is now commonly performed, with high-volume centers routinely reporting mortality rates <4% (2,3,26).

Despite significant advances in radiology techniques, between 10% and 20% of patients with pancreatic cancer undergoing operative exploration with curative intent will be found to have unresectable disease, either because of undetected distant metastases or local invasion of adjacent major vascular structures. This has let to an increased interest in the use of laparoscopy as a specific staging tool (18,27). Staging laparoscopy can be performed with minimal morbidity, identifies patients (up to 20%) with radiologically undetected metastatic disease, and does not “burn any bridges” for subsequent ...