Modified lasso technique for laparoscopic distal pancreatectomy

Hiroshi Kurahara, Kosei Maemura, Yuko Mataki, Masahiko Sakoda, Satoshi Iino, Yota Kawasaki, Koji Minami, Shinichi Ueno, Hiroyuki Shinchi, Shoji Natsugoe. Kagoshima University

INTRODUCTION: Distal pancreatectomy (DP) is a standard procedure for the treatment of malignant, premalignant, and certain benign lesions arising from the pancreatic body and tail. Laparoscopic DP has become popular in the past several years.

One of the difficulties with this approach is ligating the splenic artery and vein before transection of the pancreas. The purpose of this study was to examine the usefulness of the modified lasso technique for laparoscopic DP.

METHODS AND PROCEDURES: We reviewed the medical records of 56 patients who underwent DP with laparotomy (laparotomy group, n = 27), conventional laparoscopic surgery (conventional group, n = 26), and modified lasso technic (lasso group, n = 3). Patients with pancreatic cancer were excluded from this comparative study because they need radical resection with lymph node dissection. In the DP with laparotomy and conventional laparoscopic DP, splenic artery and vein were ligated before transection of the pancreas. In the modified lasso technique, splenic artery was clipped near the root. Thereafter, the body of the pancreas with the splenic artery and vein was retracted away from the retroperitoneum and transected using the stapler without ligation of the splenic artery and vein. We compared the clinical data between the 3 patient groups.

RESULTS: The mean operating time and amount of bleeding in the lasso group was 237 min and 10 ml, respectively. The operating time in the lasso group was significantly shorter than that in the conventional group (P = 0.002). The amount of bleeding in the lasso group was significantly less than that in the laparotomy group (P = 0.015), but there were no significant difference between the conventional group and the lasso group. There was no significant difference of postoperative complication including pancreatic fistula (PF) between the 3 groups. No patients in the lasso group experienced grade B or C PF after surgery.

CONCLUSIONS: The modified lasso technique for laparoscopic DP is useful to reduce the operating time without increasing the incidence of postoperative complication.

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