Laparo-endoscopic Single Site (less) Pancreatic Cyst Enucleation

This video demonstrates LESS resection of an 8 cm mass arising from the pancreatic body. Three 5 mm trocars were placed through one 12 mm incision using a single multi-access port at the umbilicus. A deflectable tip laparoscope was placed after insufflation of the peritoneal cavity. Division of the gastro-colic omentum and short gastric vessels was accomplished with an ultrasonic dissector. The stomach was retracted cephalad as broad mobilization of the stomach from the spleen and pancreas was achieved. The dissection was continued along the inferior border of the pancreas in an avascular plane, freeing the mesocolon and retroperitoneal fat from the pancreas and mobilizing the splenic flexure of colon. A 2-0 polypropylene suture was placed though the abdominal wall into the tumor to facilitate retraction. One of the 5 mm trocars was upsized to a 12 mm trocar; a reticulating stapler was then utilized to divide the tumor from the body of the pancreas. The specimen was resected with a normal rim of pancreas and removed with an extraction bag.

Laparo-Endoscopic Single Site (LESS) surgery is rapidly evolving in application and efficacy. Although cosmesis is undoubtedly improved, this video demonstrates excellent exposure of the pancreas and retroperitoneal structures. LESS surgical resection of distal pancreatic tumors will have a place in minimally invasive surgeons’ armamentarium for pancreatic surgery.

Session: Video Channel

Program Number: V068

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