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Lateral approach in laparoscopic distal pancreatectomy is safe and potentially beneficial compared to the traditional medial approach

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Abstract

Introduction

Laparoscopic distal pancreatectomy has become widely accepted for the treatment of left-sided pancreatic lesions. Traditionally, a medial laparoscopic distal pancreatectomy (MDLP) has been employed, with division of the gland followed by medial to lateral mobilization. Recent technical reports of lateral laparoscopic distal pancreatectomy (LLDP) suggest that it offers easier access and more precise dissection. Data on this technique remain sparse and inconclusive, with no formal comparison with MLDP. We sought to compare outcomes of LLDP to MLDP.

Methods

We reviewed the charts of patients undergoing laparoscopic distal pancreatectomy at two academic institutions, from July 2009 to June 2013. Primary outcomes were operating time and estimated blood loss. Secondary outcomes included success of spleen-preserving procedures, length of sacrificed pancreas parenchyma, margins status, 30-day major morbidity (Clavien grade 3–5 complications), and length of stay. We reported data as proportions and medians. We performed comparative analysis using Chi square test or Fisher’s exact test for categorical variables, and Mann–Whitney U test for continuous variables.

Results

We retrieved 43 cases (19 LLDP, 24 MLDP). Median operative time was shorter (166 vs 190 min; p = 0.03) and estimated blood loss lower (50 vs 250 mL; p < 0.01) with LLDP. No margin was positive with LLDP compared to 2 (8.3 %) with MLDP. Major morbidity did not differ (LLDP 21.0 % vs MLDP 25.0 %; p = 0.76). Trends toward lower conversion rate (16.7 vs 5.3 %; p = 0.36) and shorter length of stay (5 vs 4 days; p = 0.35) were not significant.

Conclusion

LLDP is a feasible and safe approach for distal lesions of the pancreatic tail, associated with shorter operative time and decreased blood loss compared to traditional MLDP. Potential of decreased conversion rate and length of stay exists. These hypotheses need to be confirmed in larger prospective studies.

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Acknowledgments

The authors would like to thank Mrs. Laura Maaske (laura@medimagery.com) for medical illustrations.

Disclosures

Matt Strickland—GestSure Technologies (founder, equity interest). Shiva Jayaraman—Astellas (speaker honorarium), Ethicon Endosurgery (consultant and academic support) and Roche (academic support). Julie Hallet, Daniel Abramowitz, Shuyin Liang, and Calvin HL Law have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of General Surgery, University of Toronto, Toronto, ON, Canada

    Matt Strickland, Julie Hallet, Daniel Abramowitz, Shuyin Liang, Calvin H. L. Law & Shiva Jayaraman

  2. Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Julie Hallet & Calvin H. L. Law

  3. Division of General Surgery, St. Joseph’s Health Centre, 30 The Queensway, Toronto, ON, M6R 1B5, Canada

    Shiva Jayaraman

Authors
  1. Matt Strickland
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  2. Julie Hallet
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  3. Daniel Abramowitz
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  4. Shuyin Liang
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  5. Calvin H. L. Law
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  6. Shiva Jayaraman
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Corresponding author

Correspondence to Matt Strickland.

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Strickland, M., Hallet, J., Abramowitz, D. et al. Lateral approach in laparoscopic distal pancreatectomy is safe and potentially beneficial compared to the traditional medial approach. Surg Endosc 29, 2825–2831 (2015). https://doi.org/10.1007/s00464-014-3997-5

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  • DOI: https://doi.org/10.1007/s00464-014-3997-5

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