Laparoscopic Spleen Preserving Distal Pancreatectomy

INTRODUCTION: Distal pancreatectomy with spleen preservation may be the preferred procedure for certain benign tumors and cystic lesion of the pancreatic body or tail. Laparoscopic distal pancreatectomy with spleen preservation has been described.We describe our method of performing laparoscopic spleen preserving distal pancreatectomy . Our operative time was 2.5 hrs, total blood loss was 100cc. the length of stay in the hospital was 7days and patient returned to work within 2 weeks.
METHODS AND PROCEDURES: A 10mm 0-degree scope was usedand the camera port was placed in the umbilicus. A 10mm working port as placed in the left mid clavicular line .A 5mm working port for retractionwas placed in right mid clavicular line. The Lesser sac wasopened and pancreas was dissected free. The Portal vein was defined along the lower border of pancreas. The portal vein wasdissected till the splenic vein was identified and skeletonised. Having dissected the splenic vein the dissection thenproceeded along the superior border of pancreas; the splenic artery was identified and dissectedaway from te pancreas. Having already lifted the pancreas from the portal vein, the pancreas was then divided usingEchelon stapler No. 55 gold cartridge. Branches of the splenic vein and artery supplying the tumor was clipped and cut taking care not to injure the splenic vasculature. Adhesions of the tumor to the spleen and splenic flexure was divided using ultrasonic shears. Having dissected the tumor all around distal pancreatectomy was completed. The specimen was placed in an endobag. A small transverse incision was placed and the specimen was delivered in toto. A tube drain was placed and the incision was closed in layers. RESULTS: The procedure was successfullyperformed laparoscopically.Total bloodloss was 100cc and the operating time was 2.5hrs. The intra and post operative period was uneventful and the patient was discharged on te 8th post operative day.
CONCLUSION: Despite large pancreatic tail tumor spleen preserving distal pancreatectomy could be performed only because of precision and magnification of laparoscopy.

Session: Video Channel

Program Number: V073