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Technique of laparoscopic left pancreatic resection preserving the splenic vessels

European Surgery - Acta Chirurgica Austriaca, ISSN: 1682-1769, Vol: 38, Issue: 3, Page: 191-196
2006
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  • Citations
    2
    • Citation Indexes
      2
  • Captures
    15

Article Description

Background: Among laparoscopic procedures, operations on the parenchymal organs including the pancreas are rather rare. The most common indications are enucleation of hormonally active endocrine tumors and distal resection for benign lesions. The most important premises for these operations include sparing of the pancreatic duct with enucleation, optimal closure of same with resections and conservation of the retropancreatic splenic vessels. Methods: Eight patients aged 16 to 71 years, 7 females and 1 male, were scheduled for laparoscopic left resection of the pancreas. There were 6 Caucasian patients and 2 female black African patients. For the 7 females, the plan was to preserve the spleen and its main vessels. For the one male, splenic preservation was not planned as he had undergone splenectomy years before in the context of an attack of pancreatitis. The operation was performed with the patient in a supine position with the legs apart. Only one case required 5 trocars, otherwise 4 sufficed, with diameters of 5-12 mm. All dissection was performed with a 5 mm Ligasure® instrument; clips were never used. The pancreas was severed with an endostapler. Results: In all 7 female patients, the operation was successfully completed laparoscopically with preservation of the splenic vessels and spleen. In the pancreatitis patient, laparoscopic resection proved impossible due to massive fibrosis and induration; conversion to open technique was required. Only this patient, required a blood transfusion. The surgical specimens included 1 mucinous and 3 serous cystadenomas, 2 solid papillary epithelial pancreatic neoplasms, a posttraumatic adrenal cyst and a highly fibrotic, necrotic pancreas. There were two cases among the female patients in which a seroma developed in the tumor bed. Both were drained under CT guidance. These two patients were discharged on the 9 and 16th postoperative days; the others between the 5th and 7th days. No patient required further surgery. Conclusions: Distal pancreas resection is an operation that by all means can be performed laparoscopically, with all the advantages of minimally invasive surgery. An important aspect of the procedure is, as with conventional open surgery, the preservation of the spleen and its main vessels. Even with larger lesions, this demanding aim can be met laparoscopically, and perhaps even more easily than with open surgery. © Springer-Verlag 2006.

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