Laparoscopic distal resection of the pancreas with the preservation of the spleen.
Management of the pancreatic diseases is still a challenge to the laparoscopic technique. Some experience has been gained in the laparoscopic exploration of the pancreas and staging in cancer. Anatomically the accessibility of the distal pancreas provides the laparoscopic approach technically feasible.


METHODS
A case of insuloma in the tail of the pancreas is presented, where distal pancreatic resection was performed laparoscopically with the preservation of the spleen. In a 55 years old female patient with typical clinical symptoms of hyperinsulinism CT identified a 3 cm large solid tumor in the tail of the pancreas. Complete mobilization of the distal pancreas was enhanced by the use of an ultrasonic dissector (UltraCision). The pancreas is detached from the splenic hilum after dividing the spleen vessels. The pancreas is transected proximally by laparoscopic linear stapler. Preservation of the short gastric vessels provides the necessary blood supply of the spleen following division of the splenic artery and vein. Thus removal of the spleen is not a necessary step in this procedure. The operation was carried out within 4.5 hours. Postoperative course was uneventful, the patient left the hospital on the 5th postoperative day. Advantages of the procedure were the earlier mobilization and shorter recovery time, less postoperative pain. The procedure can be safely performed with a good experience in both pancreatic and laparoscopic surgery.
Tihanyi
T F
TF
1st Department of Surgery, Semmelweis University of Medicine, Budapest, Hungary.
Morvay
K
K
Nehéz
L
L
Winternitz
T
T
Rusz
Z
Z
Flautner
L E
LE
D004434:Early Ambulation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis; D007340:Insulinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D009367:Neoplasm Staging; D010149:Postoperative Pain / Q000517:prevention & control; D010180:Pancreatectomy / Q000295:instrumentation / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D012449:Safety; D013154:Spleen / Q000033:anatomy & histology / Q000601:surgery*; D013157:Splenic Artery / Q000033:anatomy & histology; D013162:Splenic Vein / Q000033:anatomy & histology; D013270:Stomach / Q000098:blood supply; D013528:Surgical Staplers; D014057:Tomography, X-Ray Computed; D014465:Ultrasonics