title: Strategic Approach to the Splenic Artery in Laparoscopic Spleen-preserving Distal Pancreatectomy.
abstract: BACKGROUND
  Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is an ideal procedure in selected patients with benign or low-grade malignant tumors in the body/tail of the pancreas. We describe our procedure and experience with splenic vessel-preserving LSPDP (SVP-LSPDP) in a retrospective case series.
  
  
  METHODS
  Six consecutive patients underwent SVP-LSPDP from January 2011 to September 2013. We evaluated the courses of the splenic artery by preoperative computed tomography and applied an individualized approach (the superior approach or inferior approach) to the splenic artery.
  
  
  RESULTS
  All of the operations were successful. The median surgical duration was 249 minutes. The median blood loss was 0 mL. Pathologic examination revealed 4 cases of insulinoma, 1 case of solid pseudopapillary tumor, and 1 case of pancreatic metastasis from renal carcinoma.
  
  
  CONCLUSIONS
  In performing SVP-LSPDP, it is effective to make a strategic choice between 2 different approaches according to the course of splenic artery.
authors.affiliation: Departments of *Gastroenterological Surgery II †Diagnostic and Interventional Radiology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.
authors.forename: Kazuho
authors.initials: K
authors.lastname: Inoko
authors.forename: Yuma
authors.initials: Y
authors.lastname: Ebihara
authors.forename: Keita
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Miyamoto
authors.forename: Yo
authors.initials: Y
authors.lastname: Kurashima
authors.forename: Eiji
authors.initials: E
authors.lastname: Tamoto
authors.forename: Toru
authors.initials: T
authors.lastname: Nakamura
authors.forename: Soichi
authors.initials: S
authors.lastname: Murakami
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuchikawa
authors.forename: Keisuke
authors.initials: K
authors.lastname: Okamura
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shichinohe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013154:Spleen / Q000098:blood supply* / Q000601:surgery; D013157:Splenic Artery / Q000601:surgery*; D016896:Treatment Outcome