Yoko Wada, MD, Hisashi Kasugai, MD, Yusuke Takehara, MD, Yoshio Deguchi, MD, Hitoshi Satodate, MD, Jun-ichi Tanaka, MD, Shin-ei Kudo, MD. Showa university Norther Yokohama Hospital Digestive Desease Center
Introduction : In recent years, laparoscopic approach to the pancreatic lesion has been increasingly favored following several reports showing reductions in morbidity and hospital stay compared with open surgery. We report a case of huge MCA of the pancreas which was successfully resected with laparoscopy.
Case Report : A 50 year–old female was referred to us for management of a huge cystic lesion of the abdominal cavity. A Computed tomography (CT) and Magnetic resonance imaging (MRI) examination revealed the pancreatic cyst about 22cm in diameter and no solid lesions were seen in the cyst. The patient chief complaint was abdominal distention, laparoscopic assisted resection was performed.
Operative Procedure : The patient was placed in supine position. A median small incision (about 3 cm) was made at the upper abdomen and the peritoneal cavity was entered. The wound was protected and retracted using a wound-sealing device (Lap Protector, Hakko Medical Co., Nagano, Japan). The serous contents of the tumor was drained using the suction needle tube (S.A.N.D. balloon-catheter, Hakko Medical Co.,Nagano, Japan ) , then yielded 2600ml of serous liquid. Then a 12-mm trocar was inserted as a camera port. Another 12-mm trocar was inserted in the periumblicus, and two 5-mm trocars were inserted in the upper left abdomen. Intraoperative rapid cytological diagnosis showed no malignancy of the contents of cyst. A careful dissection of adhesions between cyst and omentum was performed intracorporeally. We resected the part of pancreatic body adjacent to the cyst with the stapler (Echelon 60 white; Ethicon Endo-Surgery Cincinnati, OH, USA). The tumor was so large that the extent of incision up to 8cm needed to remove. Operative time was 245 minutes and blood loss was estimated 180 ml with no blood transfusion.
Postoperative Course: Hospital stay was 9 days. The patient did not have postoperative pancreatitis or pancreatic leakage. Final pathology confirmed the diagnosis of MCA of the pancreas. The ovarian stromal tissue was seen in portions of tumor. The patient condition was well and asymptomatic 6 months after the procedure.
Conclusion : If this procedure had been performed with conventional open method, over 20 cm incision would be needed for this case. This procedure is safe and potentially feasible for the huge cystic lesion of the pancreas .
Program Number: P369