LAPAROSCOPIC DISTAL PANCREATECTOMY WITH SPLEEN PRESERVATION (Video Presentation)

Evangelos Nanos*, Nicolaos Durakis, Ioannkis Halikias, Maria Pappa

Abstract
Introduction: Laparoscopic Distal Pancreatectomy (LDP) is gaining wide acceptance last years although it is a complex operation. This report is presenting a video of LDP with spleen preservation technique using four ports. Laparoscopic distal pancreatectomy was performed in 4 patients from May 2010 to December 2012. Spleen was preserved in all cases. None of the patients was converted to open operation. No pancreatic leak was observed. Two of the lasions were malignant and two benign. There was no death and no complication too. Hospital stay was 5-7 days.

Technique
Under general anesthesia the patients were placed in supine position with the legs apart. The pneumoperitoneum is induced via a Verres needle inserted under the umbilicus. A 10mm camera port is inserted in this umbilical position. One port 12mm is placed below and to the left of the first port, another 5mm to the right and one more 5mm in the left upper quadrant. The gastrocolic ligament is divided as to the splenic flexure. The short gastric vessels are preserved. Pancreatic dissection starting from superior mesenteric vein to the tail of the pancreas. Further dissection of the superior pancreatic border is performed. The pancreas is divided using an endoscopic endo-stapler 60mm and the pancreatic stump is overswen with 2/0 silk. This division is including the splenic vessels. One more endo-stapler is used to divide the splenic vessels distally to pancreatic tail and close to the spleen. The specimen is extracted in an endobag. A drain is placed near the pancreatic stump.

Conclusion
Laparoscopic distal pancreatectomy is feasible and safe operation. Over sawing the pancreatic stump seems to prevent the fistula formation. The operation has obvious benefits for the patients.

*Department of Bariatric Surgery, "HYGEIAS MELATHRON HOSPITAL"
4, Therianou Street, PO 11474, Athens, Greece, e-mail: en205@otenet.gr