Laparoscopic Spleen Preserving Distal Pancreatectomy

Minimally invasive distal pancreatectomy for cystic lesions located in the body and tail of the pancreas is usually achieved with splenectomy. We report a case of a laparoscopic distal pancreatectomy with spleen preservation .
A 52 year old woman presented with a cystic lesion of the body of the pancreas. Preoperative workup including MRI , CT scan, fine needle aspiration cytology by echo-endoscopy and tumor markers suggested mucinous cystadenoma .
Under general anaesthesia, patient is positioned supine in reverse trendelenburg. Four ports are used. The greater omentum is opened, preserving the gastroepiploic vessels, to access the pancreatic area. Once the pancreas is visualized laparoscopic ultrasound is used to confirm the position and extension of the lesion and its relationship with surrounding vessels. The posterior peritoneum is incised along the inferior border of the pancreas; a plane is created posterior to the pancreas with blunt and sharp dissection to identify the superior mesenteric vein and the splenic vein. The superior border of the pancreasis delineated and the splenic artery dissected out. All pancreatic branches of the splenic vein and artery, are controlled by clips and divided. The pancreas is resected with endoscopic linear stapler and retracted to the left to continue dissecting the splenic vessels towards the spleen. A running suture is performed on the remnant stump and a drain is left adjacent to it. The specimen is extracted in an endoscopic bag by enlarging the left port site.
The postoperative course was uneventful. The patient was discharged on the 6th post-operative day. The histological report was unexpectedly serous cystadenoma.
Laparoscopic spleen-preserving distal pancreatectomy is a valid surgical option in skilled hands and selected cases for non-malignant lesions.

Session: Podium Video Presentation

Program Number: V041

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