Management of large pancreatic cystic tumor during laparoscopic distal pancreatectomy

Hodaka Moriyama, MD, Koji Asai, Manabu Watanabe, Hiroshi Matsukiyo, Tomoaki Saito, Tomotaka Ishii, Ryohei Watanabe, Toshiyuki Enomoto, Natsuya Katada, Yoshihisa Saida, Shinya Kusachi. Toho university Ohashi Medical Center

Management of large pancreatic cystic tumor during laparoscopic surgery is mandatory due to the prevention of the cystic rupture. Herein, we present the usefulness of a double-balloon catheter (SAND balloon catheter; Hacco Co, Tokyo, Japan) in laparoscopic distal pancreatectomy (Lap-DP) in the case of large pancreatic mucinous cystic neoplasm (MCN).

The case was 70-yeaer-old woman, who presented with abdominal distention, and was referred to our hospital for further examination and treatment. Imaging revealed a cystic lesion more than 20 cm in diameter extending from the pancreatic body to tail, leading to a diagnosis of MCN.

Laparoscopic finding revealed that sufficient surgical field could not be obtained because of the large pancreatic cystic lesion. After dissection of cystic surface, SAND balloon catheter was inserted in it and more than 3,000 ml fluid was suctioned out. No leak of intra-cystic fluid was observed. This procedure improved the surgical field, and enabled us to safely perform Lap-DP. Postoperative course was uneventful, and the patients was discharged on postoperative day 10.

In conclusion, we were able to safely perform Lap-DP for large MCN using the double-balloon catheter. Our results demonstrated this catheter is a useful instrument for the treatment of large pancreatic cystic tumors without leakage into the abdominal cavity.

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