Spleen and gastrosplenic ligament preserving distal pancreatectomy under a minimum incision approach assisted by laparoscopy.
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.
Hirota
Masahiko
M
Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Kumamoto, 860-0811, Japan. mhirota@krmc.or.jp
Ichihara
Atsushi
A
Furuhashi
Satoshi
S
Tanaka
Hiroshi
H
Takamori
Hiroshi
H
Baba
Hideo
H
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*