A novel technique for laparoscopic distal pancreatectomy with splenectomy

Masayasu Aikawa, MD, Mitsuo Miyazawa, MD, Shingo Ishida, MD, Yukihiro Watanabe, MD, Katsuya Okada, MD, Kojun Okamoto, MD, Shigeki Yamaguchi, MD, Isamu Koyama, MD. Saitama Medical University, International Medical Center

In laparoscopic distal pancreatectomy with splenectomy, extension of the wound is needed to extract the spleen, as the spleen is larger than the pancreas. In the present report, we describe a new technique for safe extraction of the distal pancreas along with the spleen, wherein the spleen is stored in the bag under air insufflation and the pancreas and spleen are then laparoscopically divided. This technique was employed in three cases. The patients were placed in the split-leg position and general anesthesia was administered. Moreover, we placed a camera port in the umbilical region and 4 trocars in the upper abdominal region. After the lesion was confirmed via ultrasonography, the pancreas body was divided along with the splenic vein and splenic artery. The splenic artery was then clipped and cut. The pancreas body was divided using a linear tri-stapler and reinforcement material. Thereafter, an extraction bag (Endo Catch-II™) was inserted through the umbilical wound into the abdominal cavity for storage of the pancreas body and spleen. The mouth of the bag was extracted from the abdominal cavity. Thereafter, the umbilical wound was extended by 2.0 cm, and a SILS port™ was placed at the mouth of the bag. An air insufflation into the bag could obtain sufficient working space divide the pancreas body and spleen within the bag. If the spleen was too large, it was divided into three or four portions to enable easy extraction from the abdominal cavity without the need for extending the wound.The average total duration of the operation was 398 (range, 317–412) minutes and the average duration of extraction was 64 (range, 31–92) minutes. The extracted specimens could be used for pathological staging. No operation-related complications were noted. The patients were discharged from the hospital on an average of 9 (range, 7–27) days after the operation.Through this novel method, we could perform laparoscopic distal pancreatectomy with splenectomy in a safe manner, without extending the wound size to more than 2 cm.

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