title: A single-center experience with the laparoscopic Warshaw technique in 122 consecutive patients.
abstract: Preservation of the spleen in distal pancreatectomy has recently attracted considerable attention. Our current study aimed in the first instance to define the safety of lap-WT in relation to the capacity of this technique to achieve preservation of the spleen and secondly to investigate the effectiveness of a planned lap-WT procedure or early conversion to lap-WT in selected patients with a large tumor attached to the splenic vessels.
  
  
  
  Among 1056 patients who underwent a laparoscopic distal pancreatectomy between January 2005 and December 2014 at our hospital, 122 (24.6 %) underwent lap-WT which were analyzed. The 122 patients were categorized into two groups chronologically (early group: 2005-2012, late group: 2013-2014).
  
  
  
  The median follow-up was 35 months, and the median operation time was 181 min. The median postoperative hospital stay was 7 days, and the median estimated blood loss was 316 ml. Postoperative complications occurred in 9 patients (7.3 %), including 4 patients (3.2 %) with major pancreatic fistula (ISGPF grade B, C). A reoperation to address postoperative bleeding was needed in one patient. During a median follow-up of 35 months, there were no clinical significant splenic infarctions or gastric varices in any case. All patients were observed conservatively. In patients in the late group who underwent the lap-WT, the mean operating time (171 vs. 205 min, p = 0.001) and mean estimated blood loss (232.1 vs. 370.0 ml, p = 0.017) were significantly less than the early group cases who received lap-WT.
  
  
  
  A lap-WT is a safe treatment strategy in select cases when used as a way of preserving the spleen. When splenic vessel preservation is technically challenging, for example when the tumor is enlarged or is attached to the splenic vessels, planned lap-WT or early conversion to lap-WT may be a feasible option.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Hanbaro
authors.initials: H
authors.lastname: Kim
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Ki Byung
authors.initials: KB
authors.lastname: Song
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Dae Wook
authors.initials: DW
authors.lastname: Hwang
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Shin
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Eun Sung
authors.initials: ES
authors.lastname: Jun
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Seong-Ryong
authors.initials: SR
authors.lastname: Kim
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Bong Jun
authors.initials: BJ
authors.lastname: Kwak
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Tae Gu
authors.initials: TG
authors.lastname: Kim
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Kwang-Min
authors.initials: KM
authors.lastname: Park
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea.
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, Korea. drksc@amc.seoul.kr.
authors.forename: Song Cheol
authors.initials: SC
authors.lastname: Kim
mesh_terms: D000328:Adult; D004932:Esophageal and Gastric Varices / Q000453:epidemiology; D005260:Female; D006761:Hospitals; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000601:surgery*; D061646:Operative Time; D059351:Organ Sparing Treatments; D010180:Pancreatectomy / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery; D010185:Pancreatic Fistula / Q000453:epidemiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012449:Safety; D013154:Spleen; D013157:Splenic Artery; D013159:Splenic Infarction / Q000453:epidemiology; D013162:Splenic Vein
keywords: Distal pancreatectomy; Warshaw operation