Ann Surg Treat Res.  2015 Mar;88(3):174-177. 10.4174/astr.2015.88.3.174.

Dual-incision laparoscopic spleen-preserving distal pancreatectomy

• Kim EY
• You YK
• Kim DG
• Lee SH
• Han JH
• Park SK
• Na GH
• Hong TH

• KMID: 2266877
• DOI: http://doi.org/10.4174/astr.2015.88.3.174

Abstract

Laparoscopic spleen-preserving distal pancreatectomy has been widely performed for benign and borderline malignancy in the body or tail of the pancreas when there are not oncologic indications for splenectomy. As the need for minimally invasive procedures to reduce postoperative morbidity and improve the quality of life is increasing, many surgeons have attempted to reduce the number of trocars and incision size to minimize access trauma and scarring. Single-port laparoscopic spleen-preserving distal pancreatectomy is the result of these efforts; however it has many limitations such as technical difficulty and prolonged operation time. In this article, we report the first case of dual-incision laparoscopic spleen-preserving distal pancreatectomy, proving that it can be a safe and feasible minimally invasive procedure for benign or borderline malignant tumors in the body or tail of the pancreas.

Keyword

Dual incision; Spleen-preserving distal pancreatectomy; Laparoscopy

MeSH Terms

Cicatrix
Laparoscopy
Pancreas
Pancreatectomy*
Quality of Life
Splenectomy
Surgical Instruments

Figure

• 

  Fig. 1 A 3.3 cm × 3.0 cm well-defined cystic mass in the tail of the pancreas. This mass has a peripheral solid portion with strong enhancement. (A) Axial view, (B) Coronary view.

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  Fig. 2 Extracorporeal view of the dual-incision laparoscopic spleen preserving distal pancreatectomy. We used a multichannel trocar (Glove port, Nelis, Seoul, Korea), which was composed of four trocars and two rings with gas insulation and exsufflation gates.

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  Fig. 3 Schematic diagram and intracorporeal view of the operation. (A) The operator uses his right hand with several instruments including laparoscopic dissector or grasper, and 12-mm endovascular stapler with 10-mm rigid laparoscope. (B) In the ergonomics of dual-incision laparoscopic spleen-preserving distal pancreatectomy, the operator also could use his left hand with an additional laparoscopic instrument via 5-mm subxiphoid trocar. It makes intracorporeal sutures easy.

Reference

1. Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, et al. Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg. 2007; 246:77–82.

2. Yoon YS, Lee KH, Han HS, Cho JY, Ahn KS. Patency of splenic vessels after laparoscopic spleen and splenic vessel-preserving distal pancreatectomy. Br J Surg. 2009; 96:633–640.

3. Lee SE, Jang JY, Lee KU, Kim SW. Clinical comparison of distal pancreatectomy with or without splenectomy. J Korean Med Sci. 2008; 23:1011–1014.

4. Hong TH, Lee SK, You YK, Kim JG. Singleport laparoscopic partial splenectomy: a case report. Surg Laparosc Endosc Percutan Tech. 2010; 20:e164–e166.

5. Teh SH, Tseng D, Sheppard BC. Laparoscopic and open distal pancreatic resection for benign pancreatic disease. J Gastrointest Surg. 2007; 11:1120–1125.

6. Shoup M, Brennan MF, McWhite K, Leung DH, Klimstra D, Conlon KC. The value of splenic preservation with distal pancreatectomy. Arch Surg. 2002; 137:164–168.

7. Lirici MM. Single site laparoscopic surgery: an intermediate step toward no (visible) scar surgery or the next gold standard in minimally invasive surgery? Minim Invasive Ther Allied Technol. 2012; 21:1–7.

8. Karakus SC, Kilincaslan H, Koku N, Ertaskin I. Is single port incisionless-intracorporeal conventional equipment-endoscopic surgery feasible in patients with retrocecal acute appendicitis? J Korean Surg Soc. 2013; 85:80–83.

9. Jung GO, Park DE, Chae KM. Clinical results between single incision laparoscopic cholecystectomy and conventional 3-port laparoscopic cholecystectomy: prospective case-matched analysis in single institution. J Korean Surg Soc. 2012; 83:374–380.

10. Chang SK, Lomanto D, Mayasari M. Single-port laparoscopic spleen preserving distal pancreatectomy. Minim Invasive Surg. 2012; 2012:197429.