title: Spleen and gastrosplenic ligament preserving distal pancreatectomy under a minimum incision approach assisted by laparoscopy.
abstract: BACKGROUND
  As a modification of hand-assisted laparoscopic pancreatectomy, we devised a method of spleen and gastrosplenic ligament preserving distal pancreatectomy, in which pancreatic resection is performed under direct vision extracorporeally.
  
  
  METHODS
  The distal pancreas and spleen are pulled out of the peritoneal cavity through the minilaparotomy at the epigastrium following hand-assisted laparoscopic dissection of the distal pancreas. Spleen-preserving pancreatectomy is performed safely under direct vision. The gastrosplenic ligament is also preserved to prevent splenic volvulus after the operation. The transected main pancreatic duct is doubly ligated, and the transected pancreatic stump is sewn manually. The preserved spleen and splenic vessels are placed back in the peritoneal cavity after resection.
  
  
  RESULTS
  In the current study (n = 3), overall morbidity rate, including splenic volvulus and pancreatic fistula, was 0%.
  
  
  CONCLUSIONS
  Preservation of the gastrosplenic ligament and extracorporeal preparation of the transected pancreatic stump under direct vision are useful measures in spleen-preserving distal pancreatectomy under a minimum incision approach assisted by laparoscopy.
authors.affiliation: Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Kumamoto, 860-0811, Japan. mhirota@krmc.or.jp
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ichihara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Furuhashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takamori
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008022:Ligaments / Q000601:surgery*; D008026:Ligation / Q000379:methods; D010180:Pancreatectomy / Q000379:methods*; D010183:Pancreatic Ducts / Q000601:surgery; D013154:Spleen / Q000601:surgery*