title: Modified laparoscopic splenic vessel-preserving distal pancreatectomy: Matador assistance and peel-away technique.
abstract: BACKGROUND
  Laparoscopic splenic vessel-preserving distal pancreatectomy (lap-SVPDP) is a popular procedure in pancreatic surgery. However, postoperative complications include false aneurysms of the splenic artery, splenic vein stenosis and thrombosis, pancreatic fistulas, abscess, and perigastric varices.
  
  
  METHODS
  Eight patients (three men, five women, average age 66.1 years) with benign tumors underwent lap-SVPDP. Lap-SVPDP was performed in the lithotomy position with the head slightly elevated. The splenic vein was peeled longitudinally toward the pancreatic tail. A vessel-sealing system was used to detach the pancreatic body from the greater omentum, and the pancreas was transected using a surgical stapler.
  
  
  RESULTS
  Mean operation time was 254 min; mean blood loss was 163 ml; and mean post-surgical hospitalization time was 13 days. No postoperative bleeding from the preserved splenic vessels occurred, and there were no splenic infarcts or splenic abscesses.
  
  
  CONCLUSIONS
  For safe performance of lap-SVPDP, the posterior surface of the pancreas should be completely exposed. The splenic vein should be 'peeled away', starting from its central rear, enabling easy detection of its course to avoid inadvertent sealing. With improved operational techniques, lap-SVPDP can be adopted as a standard procedure in pancreatic surgery.
authors.affiliation: Department of Surgery, Kitasato Institute Hospital, 5-9-1 Shirogane, Minato-ku, Tokyo, 108-8642, Japan, k1suzuki@me.com.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Suzuki
authors.forename: Osamu
authors.initials: O
authors.lastname: Itano
authors.forename: Go
authors.initials: G
authors.lastname: Oshima
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Osaku
authors.forename: Fumiki
authors.initials: F
authors.lastname: Asanuma
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D010180:Pancreatectomy / Q000379:methods*; D013157:Splenic Artery; D013162:Splenic Vein