Single Incision Laparoscopic Surgery for Distal Pancreatectomy-The First Reported Case in the World

Ching-Yao Yang, MD, Yu-Wen Tien, MD PhD, I-Rue Lai, MD PhD, Ming-Tsan Lin, MD PhD. National Taiwan University Hospital

Introduction:
Single incision laparoscopic surgery (SILS) is a developing advanced laparoscopic technique in recent years. It was majorly applied in appendectomy, and cholecystectomy. But SILS laparoscopic distal pancreatectomy has never been reported either in the literature or conference paper. The purpose of this study is to report the world first case of SILS laparoscopic distal pancreatectomy performed at our hospital.
Methods, and Procedures:
The 43 years old female patient had a past history of one episode of pancreatitis ten years ago. In April 2010, the patient experienced a severe dull pain in left upper abdomen with radiating to left upper back two hours later. No fever, nausea, or vomiting was noted. Abdominal sonography revealed a cystic mass in pancreatic tail with mild splenomegaly. CT and MRI revealed a lobulated mass with size about 3.7cm at pancreatic tail, and one 2 cm suspected hemangioma in right lobe of liver. Pancreatic cystadenoma was impressed. She then was referred to our OPD for further evaluation and treatment.
Results:
On May 21st of 2010, she underwent SILS laparoscopic distal pancreatectomy with en bloc resection of the spleen. The patient was placed in the right 45-degree decubitus position. A 2.5 cm periumbilical incision was made. Covidien SILS™ Port were inserted through the single incision. A flexible-tip 5-mm HD scope (Olympus) was used. Dissection was performed with 5-mm grasper and 5-mm harmonic scapel (Ethicon Endo-Surgery). Pancreatic body was transected with two EndoGIA (Covidien Autosuture Roticulator 45-4.8mm). Pancreatic tail with tumor and spleen was put in EndoBag. The bag was pulled out through the umbilical incision. Hemostasis was checked. The total operative time is 290 minutes, and blood loss is 200 cc. The patient has atelectasis in the short postoperative period. She was discharged on postoperative day 12. The pathology revealed the tumor is a 3.75cm macrocystic serous cystadenoma.
Conclusion:
SILS laparoscopic distal pancreatectomy is feasible. Due to very, very limited experience, the safety, and advantage of this advanced technique should only be performed in well selected patients, and need more comparative study in the future.