Laparo-endoscopic Single Site (less) Distal Pancreatectomy and Splenectomy

Sharona B Ross, MD, Franka Co, BS, Harold Paul, BS, Kenneth Luberice, BS, Edward Choung, MD, Alexander S Rosemurgy, MD. University of South Florida & Tampa General Medical Group


This video is of a Laparo-Endoscopic Single Site (LESS) distal pancreatectomy and splenectomy undertaken on a 62 year old gentlemen diagnosed with pancreatic adenocarcinoma Laparo-Endoscopic Single Site surgery can be efficaciously applied to a broad range of operations with the salutary benefits of multi-incisional laparoscopy but with superior cosmesis. Notably, LESS surgery provides equal and satisfactory access to all quadrants of the abdomen, providing an optimal portal for minimally invasive surgery. This video documents that LESS surgery is applicable for a safe, expeditious, and efficacious distal pancreatectomy with splenectomy.

After bupivacaine was injected into the umbilicus, a single 12mm incision was made without violating the umbilical ring. A 5mm deflectable tip laparoscope was utilized. The stomach was widely mobilized as the short gastric vessels were divided. The gastrocolic omentum was divided with bipolar cautery and wide access to the pancreas was achieved. A malleable liver retractor lifted the liver and mobilized stomach away from the pancreas, providing adequate exposure to the left gastric artery, an important landmark. The dissection was then carried along the inferior border of the pancreas toward the caudal tip of the spleen and the splenic flexure of the colon was mobilized. In dividing the pancreas, the splenic vein was first divided, then the artery, utilizing a laparoscopic linear stapler. The specimen was freed by dividing lienophrenic ligaments and was removed in an extraction bag. Hemostasis was ensured and 10ml of dilute bupivacaine solution was sprayed over the subdiaphragmatic spaces prior to specimen extraction. With minimal extension of the incision and liberal use of water-soluble lubricant, it is possible to extract a relatively large specimen through a relatively small incision. The incision was closed with absorbable suture in a figure-of-eight fashion. After recovery, there was no notable scar.

Laparo-Endoscopic Single Site (LESS) surgery will be embraced by patients for its superior cosmetic outcomes and for its promises of less pain and quicker return to daily activities. It can be undertaken safely and expeditiously without a notable postoperative scar. Patients will seek LESS surgery and surgeons will need to be able to provide it to meet patient demands.

Session Number: SS19 – Videos: HPB (Hepatobiliary and Pancreas)
Program Number: V027

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