Lateral approach for laparoscopic splenic vessel-preserving distal pancreatectomy

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• 作者：Masafumi Nakamura MD ; PhD ; ^a ; ^{mnaka@surg1.med.kyushu-u.ac.jp"" rel=""nofollow} ; Yosuke Nagayoshi MD^a ; Hiroshi Kono MD^a ; Yasuhisa Mori MD^a ; Takao Ohtsuka MD ; PhD^a ; Shunichi Takahata MD ; PhD^a ; Shuji Shimizu MD ; PhD^a ; Masao Tanaka MD ; PhD ; FACS^a
• 刊名：Surgery
• 出版年：2011
• 出版时间：August 2011
• 年：2011
• 卷：150
• 期：2
• 页码：326-331
• 全文大小：556 K

文摘

Aim

We sought to evaluate the feasibility of the lateral approach for laparoscopic splenic vessel-preserving distal pancreatectomy (LA-SVPDP).

Background

Complete preservation of the splenic vessels is an ideal outcome in spleen-preserving distal pancreatectomy (SPDP). However, the preservation of the vessels is challenging in laparoscopic surgery because the splenic vein is often embedded in the pancreatic parenchyma. Herein we have described LA-SVPDP, the most feasible method for laparoscopic SPDP, and the outcome of our initial experience.

Patients

Twenty-three patients underwent laparoscopic SPDP. Before we adopted LA-SVPDP, 8 patients underwent the Warshaw method and 6 underwent SVPDP. After the adoption of LA-SVPDP, 8 patients underwent LA-SVPDP and 1 donor underwent the Warshaw method.

Results

None of patients undergoing LA-SVPDP required conversion to an open operation, whereas 2 patients undergoing the other procedures were converted to open operations. Five out of 8 patients who underwent the Warshaw method showed engorgement of the gastric veins, revealed by computed tomography. However, only 1 of the 5 patients showed mild gastric varices on endoscopy.

Conclusion

Although the Warshaw method is acceptable with a low incidence of gastric varices in our analysis, SVPDP is a feasible approach for SPDP. Our LA-SVPDP technique may contribute to safer and easier SVPDP in laparoscopic surgery.