title: Single-incision laparoscopic distal pancreatectomy with or without splenic preservation: how we do it.
abstract: BACKGROUND
  Recent interest in improving cosmetic outcomes has led to single-incision laparoscopic surgery (SILS) being performed in a variety of organs. However, this innovative technique has rarely been introduced in pancreatic surgery, as it is considered to be a challenging procedure. We report herein our technique of single-incision laparoscopic distal pancreatectomy with or without splenic preservation.
  
  
  METHODS
  A 2.5-cm intraumbilical mini-laparotomy was made for the placement of a SILS Port as a single access site. The overall procedures were similar to those performed in the standard laparoscopic distal pancreatectomy with multiple trocars. To obtain better exposure of the operative field, we made technical refinements by employing gastric suspension with sutures, the tug-exposure technique, a balloon retractor, and gravity by changing the patient's position. The pancreas was transected with a linear stapler, and the specimen was extracted through the umbilical wound.
  
  
  CONCLUSIONS
  Patients were discharged without any complications. The umbilical wounds were almost invisible 1 month after surgery. We believe that SILS, with some technical refinements, can be safely applied for distal pancreatectomy. Although the cosmetic benefits of single-incision laparoscopic distal pancreatectomy are obvious, several issues such as the extent of invasiveness, cost, indications, and learning curve need to be investigated.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. take-misawa@jikei.ac.jp
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Ito
authors.forename: Yasuro
authors.initials: Y
authors.lastname: Futagawa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kitamura
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tsutsui
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.forename: Shigeki
authors.initials: S
authors.lastname: Wakiyama
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010181:Pancreatic Cyst / Q000601:surgery; D013154:Spleen