Laparoscopic distal pancreatectomy has emerged as an attractive minimally invasive alternative for selected patients. Although technically challenging, distal pancreatectomy with splenic artery preservation has consistently been correlated with reduced blood loss and perioperative morbidity in multiple studies. Herein presented is our technique for completely laparoscopic (non-hand-assisted) subtotal pancreatectomy with splenic artery preservation (LSP-SAP).
An 87-year-old woman with an incidentally identified 3-cm cystic lesion in the pancreatic body–tail interface underwent EUS, which supported side-branch intraductal papillary mucinous neoplasm. The patient subsequently underwent laparoscopic resection. A completely laparoscopic procedure was performed using a four-trochar technique. The tail and body of the pancreas were dissected off of the retroperitoneum along the embryologic plane and separated from the colonic splenic flexure. Next, the splenic artery was dissected, isolated, and preserved, while the splenic vein was dissected off the ventral pancreas up to the level of the splenic–portal vein confluence. The technique employed a bipolar cutter-sealing device for dissection and hemostasis. Pancreatic parenchymal transection was performed with a standard vascular load endomechanical stapling device.
Total procedure time was 210 min, and the estimated blood loss was 200 mL. Postoperatively, the patient was admitted, advanced to regular diet the next day, and discharged home on postoperative day 3. The pathological review of the specimen revealed high-grade dysplasia with a non-invasive malignant component, classified as intraductal carcinoma. Foci of PanIN 1–3 were identified with no high grade dysplasia at the surgical margin. Five lymph nodes were included in the specimen and were negative for malignancy.
Completely LSP-SAP can be safely performed in selected patients. This procedure may be an optimal alternative to open surgery.
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Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 2005;137:597–605.
Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 1999;229:693–698. (discussion 698–700).
Lightner AM, Glasgow RE, Jordan TH, Krassner AD, Way LW, Mulvihill SJ, Kirkwood KS. Pancreatic resection in the elderly. J Am Coll Surg 2004;198:697–706.
Tang CN, Tsui KK, Ha JP, Wong DC, Li MK. Laparoscopic distal pancreatectomy: a comparative study. Hepatogastroenterology 2007;54:265–271.
Patterson EJ, Gagner M, Salky B, Inabnet WB, Brower S, Edye M, Gurland B, Reiner M, Pertsemlides D. Laparoscopic pancreatic resection: single-institution experience of 19 patients. J Am Coll Surg 2001;193:281–287.
Fabre JM, Dulucq JL, Vacher C, Lemoine MC, Wintringer P, Nocca D, Burgel JS, Domergue J. Is laparoscopic left pancreatic resection justified? Surg Endosc 2002;16:1358–1361.
Park AE, Heniford BT. Therapeutic laparoscopy of the pancreas. Ann Surg 2002;236:149–158.
Edwin B, Mala T, Mathisen O, Gladhaug I, Buanes T, Lunde OC, Soreide O, Bergan A, Fosse E. Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 2004;18:407–411.
Taylor C, O’Rourke N, Nathanson L, Martin I, Hopkins G, Layani L, Ghusn M, Fielding G. Laparoscopic distal pancreatectomy: the Brisbane experience of forty-six cases. HPB (Oxford) 2008;10:38–42.
Govil S, Imrie CW. Value of splenic preservation during distal pancreatectomy for chronic pancreatitis. Br J Surg 1999;86:895–898.
Hutchins RR, Hart RS, Pacifico M, Bradley NJ, Williamson RC. Long-term results of distal pancreatectomy for chronic pancreatitis in 90 patients. Ann Surg 2002;236:612–618.
Schwarz RE, Harrison LE, Conlon KC, Klimstra DS, Brennan MF. The impact of splenectomy on outcomes after resection of pancreatic adenocarcinoma. J Am Coll Surg 1999;188:516–521.
Vezakis A, Davides D, Larvin M, McMahon MJ. Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg Endosc 1999;13:26–29.
Fernandez-Cruz L, Martinez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S. Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J Gastrointest Surg 2004;8:493–501.
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Boutros, C., Espat, N.J. & Somasundar, P. Completely Laparoscopic Subtotal Pancreatectomy with Splenic Artery Preservation. J Gastrointest Surg 14, 171 (2010). https://doi.org/10.1007/s11605-009-0995-3
- Splenic artery preservation