Retroperitoneoscopic laparoscopic distal pancreatectomy with spleen salvage.
OBJECTIVE
Laparoscopic pancreatic surgery has now developed as a clinical practice. In urological surgery, direct extraperitoneal surgery has become popular in laparoscopic adrenalectomy and nephrectomy. As the pancreas is also an organ located in the retroperitoneal cavity, we evaluate the efficacy of retroperitoneoscopic laparoscopic distal pancreatectomy.


METHODS
Specific-pathogen-free Large Yorkshire pigs were studied. No major bleeding episodes were encountered. After carbon dioxide insufflation, the abdominal viscera were inspected with a laparoscope. Below the left costal convexity, the balloon dissector was introduced and the second port was inserted in the retroperitoneal cavity. The scope was inserted using that port and additional two ports were inserted into the retroperitoneal cavity.


RESULTS
The tail to body of the pancreas were easily mobilized from the retroperitoneum. The identified splenic artery and vein were carefully isolated from the pancreas. After lap-disk was applied to a 4-cm incision, the tail of the pancreas was pulled out to resect using various devices. The cut surface of the pancreas resected with ultrasonic dissector showed a less damaged area than that with monopolar electrocautery and bipolar electrocautery.


CONCLUSIONS
Retroperitoneoscopic laparoscopic distal pancreatectomy is a rational procedure and is safe. As the pancreatic parenchyma has greater water content, the devices of ultrasonic dissector seem to be helpful.
Takada
Moriatsu
M
Department of Gastroenterological Surgery, Graduate School of Medical Sciences Kobe University, Kobe, Japan. moriatsu@med.kobe-u.ac.jp
Ichihara
Takao
T
Toyama
Hirochika
H
Suzuki
Yasuyuki
Y
Kuroda
Yoshikazu
Y
D000818:Animals; D004210:Dissection / Q000295:instrumentation; D004564:Electrocoagulation / Q000295:instrumentation; D010535:Laparoscopy; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy / Q000295:instrumentation / Q000379:methods*; D012187:Retroperitoneal Space / Q000601:surgery*; D013010:Sonication / Q000295:instrumentation; D013154:Spleen / Q000601:surgery*; D013552:Swine