Single Incision Laparoscopic Pancreatic Surgery – Early Experience

Gadiyaram Srikanth, MCh, Neel Shetty, DNB. Manipal Institute of Liver and Digestive Diseases

Background: Feasiblity of single incision laparoscopic (SIL) surgery has been demonstrated with variety of abdominal procedures, viz cholecystectomy, appendectomy, splenectomy etc. We herein report two patients who underwent SIL procedures for pancreatic disorders.

Case Report 1: A 46 year old gentleman, presented with pain abdomen and loose stools. Clinical exam and laboratory tests revealed no abnormality. His Serum Chromogranin A levels were elevated at 970ng/ml and an endoscopic ultrasound guided fine needle aspiration of the lesion showed a neuro-endocrine tumor. Computerised tomography (CT) of the abdomen showed a well circumscribed tumor in the tail of pancreas with infiltration into the splenic hilum. He underwent a Single Incision Laparoscopic Distal Pancreatectomy and Splenectomy. Histopathology showed a well differentiated neuroendocrine carcinoma with negative margins and no nodal involvement. The post operative period was uneventful and he was discharged on the 6th post operative day. He presented with an intraabdominal collections two weeks later which was managed by percutaneous catheter drainage.
Case Report 2: A 48 years old female patient presented with pain abdomen following an episode of acute pancreatitis (idiopathic). CT of the abdomen showed a pseudocyst in relation to the tail of pancreas. A SIL cystogastrostomy was performed. She was discharged from the hospital on third postoperative day. She was readmitted and managed conservatively for a self-limiting upper gastrointestinal bleed from the cystogastrostomy anastomosis site (on upper endoscopy).

Conclusion: We demonstrated the feasibility of SILS approach for distal pancreatectomy and cystogastrostomy. Longer laparoscope, use of innovative stomach retraction technique, stapling device and endosuturing skills facilitated the procedures. Complications which occurred were unrelated to the SILS approach but to the nature of procedure and were managed appropriately. We need larger studies to study the usefulness of SILS approach in the surgical management of pancreatic disorders.