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Strategic Approach to the Splenic Artery in Laparoscopic Spleen-preserving Distal Pancreatectomy.

Inoko K, Ebihara Y, Sakamoto K, Miyamoto N, Kurashima Y, Tamoto E, Nakamura T, Murakami S, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S - Surg Laparosc Endosc Percutan Tech (2015)

Bottom Line: All of the operations were successful.The median surgical duration was 249 minutes.In performing SVP-LSPDP, it is effective to make a strategic choice between 2 different approaches according to the course of splenic artery.

View Article: PubMed Central - PubMed

Affiliation: Departments of *Gastroenterological Surgery II †Diagnostic and Interventional Radiology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.

ABSTRACT

Background: Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is an ideal procedure in selected patients with benign or low-grade malignant tumors in the body/tail of the pancreas. We describe our procedure and experience with splenic vessel-preserving LSPDP (SVP-LSPDP) in a retrospective case series.

Methods: Six consecutive patients underwent SVP-LSPDP from January 2011 to September 2013. We evaluated the courses of the splenic artery by preoperative computed tomography and applied an individualized approach (the superior approach or inferior approach) to the splenic artery.

Results: All of the operations were successful. The median surgical duration was 249 minutes. The median blood loss was 0 mL. Pathologic examination revealed 4 cases of insulinoma, 1 case of solid pseudopapillary tumor, and 1 case of pancreatic metastasis from renal carcinoma.

Conclusions: In performing SVP-LSPDP, it is effective to make a strategic choice between 2 different approaches according to the course of splenic artery.

No MeSH data available.


Related in: MedlinePlus

Approach to the splenic artery. A, Superior approach. B, Inferior approach. SA indicates splenic artery; SV, splenic vessel.
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Figure 2: Approach to the splenic artery. A, Superior approach. B, Inferior approach. SA indicates splenic artery; SV, splenic vessel.

Mentions: The left hepatic lobe was kept elevated, using a laparoscopic retractor through the left paraxiphoid trocar. The greater omentum was divided below the gastroepiploic arch to open a window to the bursa omentalis. Then, the window was enlarged to expose the pancreas, while the left gastroepiploic vessels and short gastric vessels were preserved. Laparoscopic ultrasonography was used supportively to identify the location of the tumor, and a surgical resection line was predetermined. When the course of the splenic artery was Type A, the peritoneum was cut along the superior pancreatic border to expose and tape the splenic artery at the dividing line (the superior approach) (Fig. 2A).


Strategic Approach to the Splenic Artery in Laparoscopic Spleen-preserving Distal Pancreatectomy.

Inoko K, Ebihara Y, Sakamoto K, Miyamoto N, Kurashima Y, Tamoto E, Nakamura T, Murakami S, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S - Surg Laparosc Endosc Percutan Tech (2015)

Approach to the splenic artery. A, Superior approach. B, Inferior approach. SA indicates splenic artery; SV, splenic vessel.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4539197&req=5

Figure 2: Approach to the splenic artery. A, Superior approach. B, Inferior approach. SA indicates splenic artery; SV, splenic vessel.
Mentions: The left hepatic lobe was kept elevated, using a laparoscopic retractor through the left paraxiphoid trocar. The greater omentum was divided below the gastroepiploic arch to open a window to the bursa omentalis. Then, the window was enlarged to expose the pancreas, while the left gastroepiploic vessels and short gastric vessels were preserved. Laparoscopic ultrasonography was used supportively to identify the location of the tumor, and a surgical resection line was predetermined. When the course of the splenic artery was Type A, the peritoneum was cut along the superior pancreatic border to expose and tape the splenic artery at the dividing line (the superior approach) (Fig. 2A).

Bottom Line: All of the operations were successful.The median surgical duration was 249 minutes.In performing SVP-LSPDP, it is effective to make a strategic choice between 2 different approaches according to the course of splenic artery.

View Article: PubMed Central - PubMed

Affiliation: Departments of *Gastroenterological Surgery II †Diagnostic and Interventional Radiology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.

ABSTRACT

Background: Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is an ideal procedure in selected patients with benign or low-grade malignant tumors in the body/tail of the pancreas. We describe our procedure and experience with splenic vessel-preserving LSPDP (SVP-LSPDP) in a retrospective case series.

Methods: Six consecutive patients underwent SVP-LSPDP from January 2011 to September 2013. We evaluated the courses of the splenic artery by preoperative computed tomography and applied an individualized approach (the superior approach or inferior approach) to the splenic artery.

Results: All of the operations were successful. The median surgical duration was 249 minutes. The median blood loss was 0 mL. Pathologic examination revealed 4 cases of insulinoma, 1 case of solid pseudopapillary tumor, and 1 case of pancreatic metastasis from renal carcinoma.

Conclusions: In performing SVP-LSPDP, it is effective to make a strategic choice between 2 different approaches according to the course of splenic artery.

No MeSH data available.


Related in: MedlinePlus