Laparoscopic Resection of Benign Tumor Localized in the Neck of the Pancreas With Spleen Preservation

Yuedong Wang, MD PhD, Yangwen Zhu, MD, Jia Wu, MD, Zhijie Xie, MD, Xiaoli Zhan, MD. Zhejiang Provincial People’s Hospital


Background Mastery of laparoscopic skills and advances in technology have allowed a wide range of minimally invasive procedures to replace their open counterparts, including pancreatic surgery. The technique of distal pancreatectomy (resection of the pancreatic body and tail) has been well described, both with or without preservation of the spleen. However, to date we have not seen any reports about the laparoscopic resection for benign tumor localized in the neck of the pancreas with spleen preservation. This study was designed to present video of pure laparoscopic resection for benign tumor localized in the neck of the pancreas with spleen preservation.
Methods A 20-year-old female presented to us with the chief complaint of dull pain in the upper abdomen for one month. CT scan disclosed a cyst-solid mass of 4.5×4 cm located in the neck and body of the pancreas, without infiltrating to surrounding tissue. The procedure began by using ultrasonic scalpel to divide the gastrocolic ligament to enter the lesser sac to allow for complete visualization of the distal pancreas, and the tumor was identified. The peritoneum overlying the superior and inferior margin of the pancreas was incised with the ultrasonic scalpel. Careful blunt dissection of the dorsal aspect of the neck of the pancreas was performed. To the right of the tumor, the pancreas was transected with the linear cutting stapler using a vascular cartridge. The dissection was continued in a way of medial-to-lateral of the pancreas. Individual branches of the splenic artery and vein were divided with the ultrasonic scalpel or clips and scissors until the distal pancreas was totally free. The specimen was placed in a bag, then retrieved through the 12-mm port which was enlarged slightly.
Results The operation was completed in 150 minutes, and the blood loss was about 100ml. The patient recovered from the surgery smoothly, no postoperative complication occurred. A clear liquid diet was begun when the patient passed flatus on postoperative day 2, and the postoperative hospital stay was 6 days. The pathologic diagnosis was solid-pseudopapillary tumor of the pancreas.
Conclusions Laparoscopic extended distal pancreatectomy with preservation of the spleen and splenic vessels is a feasible and safe option for the management of benign tumor in the neck and body of the pancreas.

 Keywords Laparoscopy . Extended distal pancreatectomy . Spleen preservation

Session Number: VidTV1 – Video Channel Rotation Day 1
Program Number: V091

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