Laparoscopic Distal Pancreatectomy With Splenectomy for Serous Cystic Tumor in Proximal Body of Pancreas

Srikanth Gadiyaram, MCh, Neel Shetty, DNB, Sunil Alur, DNB, Jayanth Reddy, MCh. Institute of Gastroenterology, BGS Global Hospitals, Bangalore

 

Laparoscopic distal pancreatic resection is becoming the preferred approach in patients with cystic tumors in the body and tail of pancreas. We herein present an operative video of a patient with a serous cystic neoplasm in the proximal body of pancreas who underwent distal pancreato-splenectomy.
Case report: 69 year old male patient presented with pain in the mid-epigastrium of 3 months duration. His laboratory tests including Ca 19-9 were within normal limits. Multi detector computerized tomography of the abdomen revealed a cystic neoplasm in the proximal body of pancreas. The posterior surface of the tumor was seen abutting the spleno-portal confluence with the medial end reaching the neck of pancreas. Patient received prophylactic vaccination against pneumococccus, meningococcus and hemophilus influenza two weeks prior to surgery. A laparoscopic distal pancreatectomy with splenectomy was performed utilizing 5 ports. Operative procedure was performed in seven steps. Step 1: Lesser sac was entered by dividing gastrocolic omentum. Step 2: Defining inferior border of pancreas. Step 3: Dissection of retropancreatic tunnel in an avascular plane anterior to the portal vein behind the neck of pancreas . Step 4: Endo GIA staple transaction of neck of pancreas. Step 5: Clipping and division of splenic vessels. Step 6: Dissection of distal pancreas and spleen in an avascular plane from retroperitoneum . Step 7: Bagging the specimen and retrieval by enlarging the umbilical port site. Operative video is presented.


Session Number: Poster – Poster Presentations
Program Number: P356
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