title: Case-matched study of lesser versus greater curvature approach in laparoscopic Warshaw pancreatectomy.
abstract: BACKGROUND
  In laparoscopic distal pancreatectomy (LapDP), the pancreas is accessed in a greater curvature approach (GCA). The lesser curvature approach (LCA) has been proposed in underweight patients. The study investigated the feasibility of LCA irrespective of the body mass index (BMI).
  
  
  METHODS
  This retrospective study included consecutive patients scheduled to undergo LapDP with the LCA. A matched cohort (1:1) underwent GCA. Spleen preservation was performed using the Warshaw technique. Splenic perfusion was intraoperatively assessed by indocyanine green (ICG) angiography.
  
  
  RESULTS
  The LCA with LapDP was successful in 12/15 patients. In 2 cases, LCA had to be converted to GCA and in 1 patient to open surgery. The cohorts were well matched in sex (P = 1.0), age (P = .67), indication (P = 1.0), and median BMI (23.4 kg/m2vs 24.8 kg/m2, P = .41). Splenic preservation was achieved in 14/15 patients with LCA and 4/15 patients with GCA (P = .33). In all LCA cases, ICG angiography indicated sufficient spleen perfusion. The groups had similar morbidity (P = 1.0) and hospital stay (P = .74).
  
  
  CONCLUSIONS
  LCA was feasible in 80% irrespective of BMI and provided an excellent field of exposure. ICG angiography was feasible in the Warshaw technique. Its reliability should be evaluated in prospective studies.
authors: Berner Viszeralchirurgie, Klinik Beau-Site, Hirslanden, Schänzlihalde 11, 3013 Bern, Switzerland; Department of General-, Visceral- and Transplant Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Philip C
authors: PC
authors: Müller
authors: Berner Viszeralchirurgie, Klinik Beau-Site, Hirslanden, Schänzlihalde 11, 3013 Bern, Switzerland.
authors: Sascha A
authors: SA
authors: Müller
authors: Department of General-, Visceral- and Transplant Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
authors: Daniel C
authors: DC
authors: Steinemann
authors: Berner Viszeralchirurgie, Klinik Beau-Site, Hirslanden, Schänzlihalde 11, 3013 Bern, Switzerland.
authors: Michael S
authors: MS
authors: Pärli
authors: Berner Viszeralchirurgie, Klinik Beau-Site, Hirslanden, Schänzlihalde 11, 3013 Bern, Switzerland.
authors: Felix
authors: F
authors: Moltzahn
authors: Berner Viszeralchirurgie, Klinik Beau-Site, Hirslanden, Schänzlihalde 11, 3013 Bern, Switzerland.
authors: Stefan W
authors: SW
authors: Schmid
authors: Berner Viszeralchirurgie, Klinik Beau-Site, Hirslanden, Schänzlihalde 11, 3013 Bern, Switzerland. Electronic address: kaspar.zgraggen@hirslanden.ch.
authors: Kaspar
authors: K
authors: Z'graggen
mesh_terms: D000368:Aged; D000792:Angiography; D016022:Case-Control Studies; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D013154:Spleen / Q000098:blood supply / Q000000981:diagnostic imaging
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: ICG; Laparoscopic distal pancreatectomy; Laparoscopic pancreatic techniques; Lesser curvature approach; Splenic perfusion; Splenic preservation