Cancer Of The Body Of Pancreas: Techniques For Laparoscopic Distal Pancreatectomy In The Setting Of Severe Inflammation

Thomas Schnelldorfer. Lahey Hospital & Medical Center.

The operative technique of laparoscopic distal pancreatectomy with splenectomy will be demonstrated in two patients with adenocarcinoma in the body of pancreas and prior episodes of severe acute pancreatitis from pancreatic ductal obstruction. This video emphasizes the technique of safe laparoscopic resection despite extensive inflammatory changes in the peripancreatic and retroperitoneal tissue. It further demonstrates the feasibility of margin negative resection in a setting of severe inflammation. The video shows that preoperative imaging helps to predict the degree of inflammation and therefore the difficulty for operative resection. It emphasizes on techniques that should be considered in the setting of severe pancreatitis, such as transection of the pancreas in the area of least inflammation. For lesions in the body or tail this is typically the neck of the pancreas potentially requiring an extended distal pancreatectomy as demonstrated in the first patient. Retroperitoneal structures can sometimes be hidden behind dense scar tissue. And to help identifying the right anatomic plane and any hidden structures, hand-assisted retroperitoneal dissection might be necessary in selected patients with severe retroperitoneal scaring.

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