title: Lateral approach for laparoscopic splenic vessel-preserving distal pancreatectomy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. mnaka@surg1.med.kyushu-u.ac.jp
authors: Masafumi
authors: M
authors: Nakamura
authors: Yosuke
authors: Y
authors: Nagayoshi
authors: Hiroshi
authors: H
authors: Kono
authors: Yasuhisa
authors: Y
authors: Mori
authors: Takao
authors: T
authors: Ohtsuka
authors: Shunichi
authors: S
authors: Takahata
authors: Shuji
authors: S
authors: Shimizu
authors: Masao
authors: M
authors: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery*; D013154:Spleen / Q000098:blood supply; D013157:Splenic Artery / Q000601:surgery*; D013162:Splenic Vein / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult