Initial experience with hand-assisted laparoscopic distal pancreatectomy

  • M. D’Angelica
  • C. Are
  • W. Jarnagin
  • G. DeGregoris
  • D. Coit
  • D. Jaques
  • M. Brennan
  • Y. Fong



Hand-assisted laparoscopic distal pancreatectomy, with or without splenectomy, is gradually gaining acceptance, although its ultimate benefit is yet to be confirmed. This study aimed to report our initial experience with hand-assisted laparoscopic distal pancreatectomy.


A retrospective review of a prospectively collected database including 17 patients during the period 2002–2004 was conducted. The median age was 60 years (range, 29–85 years), and the female-to-male ratio was 13:4. The preoperative diagnoses included benign and malignant conditions. Besides two to three ports, a hand port was placed in the upper midline to aid in dissection. The pancreas was divided with a stapler in all the patients, and drains were placed in 10 patients (70%).


One patient was found to be unresectable because of celiac artery involvement, and 2 of the remaining 16 patients underwent conversion to an open procedure. The median operating time was 196 min (range, 128–235 min). The mean tumor size was 4 cm (range, 2–7 cm), and the estimated blood loss was 125 ml (range, 50–1,250 ml). The median time to resumption of a regular diet was 3.5 days (range, 2–9 days), and the time to conversion to oral pain medications was 3 days (range, 2–9 days). The length of hospital stay was 5.5 days (range, 4–18 days), with a majority of the patients (11 patients, 78%) staying less than 7 days. There were no mortalities. The overall postoperative morbidity rate was 25%, and the morbidities consisted of pancreatic leak/fistula (2 patients, 14%) and fever (1 patient). The margins were negative in 10 (76%) of the relevant 13 patients. At a median follow-up period of 3.8 months (range, 5–14 months), 11 (84%) of 13 patients had no evidence of disease recurrence.


The minimally invasive approach to pancreatic disease is safe and technically feasible. Further large studies with longer follow-up periods are necessary to determine the role of laparoscopic surgery in the management of pancreatic disease.


Hand-assisted Laparoscopic distal pancreatectomy Minimally invasive Pancreatectomy Pancreatic disease 


  1. 1.
    Aldridge MC, Williamson RCN (1991) Distal pancreatectomy with and without splenectomy. Br J Surg 78: 976–979PubMedGoogle Scholar
  2. 2.
    Balcom JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C (2001) Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 136: 391–397PubMedCrossRefGoogle Scholar
  3. 3.
    Benoist S, Dugue L, Sauvanet A, Valverde A, Mauvais F, Paye F, Farges O, Belghiti J (1999) Is there a role of preservation of the spleen in distal pancreatectomy? J Am Coll Surg 188: 255–260PubMedCrossRefGoogle Scholar
  4. 4.
    Brennan MF, Moccia RD, Klimstra D (1996) Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 223: 506–511PubMedCrossRefGoogle Scholar
  5. 5.
    Cuschieri A (2000) Laparoscopic hand-assisted surgery for hepatic and pancreatic disease. Surg Endosc Other Intervent Tech 14: 991–996Google Scholar
  6. 6.
    Cuschieri A, Jakimowicz JJ, vanSpreeuwel J (1996) Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg 223: 280–285PubMedCrossRefGoogle Scholar
  7. 7.
    de Wilt JHW, van Eijck CHJ, Hussain SM, Bonjer HJ (2003) Laparoscopic spleen-preserving distal pancreatectomy after blunt abdominal trauma. Injury Int J Care Injured 34: 233–234Google Scholar
  8. 8.
    Edwin B, Mala T, Mathisen O, Gladhaug I, Buanes T, Lunde OC, Soreide O, Bergan A, Fosse E (2004) Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 18: 407–411PubMedCrossRefGoogle Scholar
  9. 9.
    Fabre JM, Dulucq JL, Vacher C, Lemoine MC, Wintringer P, Nocca D, Burgel JS, Domergue J (2002) Is laparoscopic left pancreatic resection justified? Surg Endosc Other Intervent Tech 16: 1358–1361Google Scholar
  10. 10.
    Fahy BN, Frey CF, Ho HS, Beckett L, Bold RJ (2002) Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 183: 237–241PubMedCrossRefGoogle Scholar
  11. 11.
    Fernandez-Cruz L, Martinez I, Gilabert R, Cesar-Borges G, Astudillo E, Navarro S (2004) Laparoscopic distal pancreatectomy combined with preservation of the spleen for cystic neoplasms of the pancreas. J.Gastrointest.Surg 8: 493–501PubMedCrossRefGoogle Scholar
  12. 12.
    Fernandez-Cruz L, Saenz A, Astudillo E, Pantoja JP, Uzcategui E, Navarro S (2002) Laparoscopic pancreatic surgery in patients with chronic pancreatitis. Surg Endosc Other Intervent Tech 16: 996–1003Google Scholar
  13. 13.
    Gagner M, Pomp A (1997) Laparoscopic pancreatic resection: is it worthwhile? J Gastrointest Surg 1: 20–26PubMedCrossRefGoogle Scholar
  14. 14.
    Goletti O, Celona G, Monzani F, Caraccio N, Zocco G, Lippolis PV, Battini A, Seccia M, Cavinal E (2003) Laparoscopic treatment of pancreatic insulinoma. Surg Endosc Other Intervent Tech 17:1499Google Scholar
  15. 15.
    Govil S, Imrie CW (1999) Value of splenic preservation during distal pancreatectomy for chronic pancreatitis. Br J Surg 86: 895–898PubMedCrossRefGoogle Scholar
  16. 16.
    Gramatica L, Herrera MF, Mercado-Luna A, Sierra M, Verasay G, Brunner N (2002) Videolaparoscopic resection of insulinomas: experience in two institutions. World J Surg 26: 1297–1300PubMedCrossRefGoogle Scholar
  17. 17.
    Hernandez DJ, Kavoussi LR, Ellison LM (2003) Laparoscopic distal pancreatectomy for metastatic renal cell carcinoma. Urology 62: 551PubMedCrossRefGoogle Scholar
  18. 18.
    Hutchins RR, Hart RS, Pacifico M, Bradley NJ, Williamson RCN (2002) Long-term results of distal pancreatectomy for chronic pancreatitis in 90 patients. Ann Surg 236: 612–618PubMedCrossRefGoogle Scholar
  19. 19.
    Katkhouda N, Lord RV (2000) Once more, with feeling: handoscopy or the rediscovery of the virtues of the surgeon’s hand. Surg Endosc Ultrasound Intervent Tech 14: 985–986Google Scholar
  20. 20.
    Klingler PJ, Hinder RA, Menke DM, Smith SL (1998) Hand-assisted laparoscopic distal pancreatectomy for pancreatic cystadenoma. Surg Laparosc Endosc 8: 180–184PubMedCrossRefGoogle Scholar
  21. 21.
    Konishi T, Hiraishi M, Kubota K, Bandai Y, Makuuchi M, Idezuki Y (1995) Segmental occlusion of the pancreatic duct with prolamine to prevent fistula formation after distal pancreatectomy. Ann Surg 221: 165–170PubMedGoogle Scholar
  22. 22.
    Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229: 693–700PubMedCrossRefGoogle Scholar
  23. 23.
    Mahon D, Allen E, Rhodes M (2002) Laparoscopic distal pancreatectomy: three cases of insulinoma. Surg Endosc Other Intervent Tech 16: 700–702Google Scholar
  24. 24.
    Park AE, Heniford BT (2002) Therapeutic laparoscopy of the pancreas. Ann Surg 236: 149–158PubMedCrossRefGoogle Scholar
  25. 25.
    Patterson EJ, Gagner M, Salky B, Inabnet WB, Brower S, Edye M, Gurland B, Reiner M, Pertsemlides D. (2001) Laparoscopic pancreatic resection: single-institution experience of 19 patients. J Am Coll Surg 193: 281–287PubMedCrossRefGoogle Scholar
  26. 26.
    Reynolds EM, Curnow AJ (2003) Laparoscopic distal pancreatectomy for traumatic pancreatic transection. J Pediatr Surg 38: E7–9PubMedCrossRefGoogle Scholar
  27. 27.
    Romanelli JR, Kelly JJ, Litwin DE (2001) Hand-assisted laparoscopic surgery in the United States: an overview. Semin Laparosc Surg 8: 96–103PubMedCrossRefGoogle Scholar
  28. 28.
    Shinchi H, Takao S, Noma H, Mataki Y, Iino S, Aikou T (2001) Hand-assisted laparoscopic distal pancreatectomy with minilaparotomy for distal pancreatic cystadenoma. Surg Laparosc Endosc Percutan Tech 11: 139–143PubMedCrossRefGoogle Scholar
  29. 29.
    Shoup M, Brennan MF, McWhite K, Leung DHY, Klimstra D, Conlon KC (2002) The value of splenic preservation with distal pancreatectomy. Arch Surg 137: 164–168PubMedCrossRefGoogle Scholar
  30. 30.
    Soper NJ, Brunt LM, Kerbl K (1994) Laparoscopic general surgery. N Engl J Med 330:409–419PubMedCrossRefGoogle Scholar
  31. 31.
    Tagaya N, Kasama K, Suzuki N, Taketsuka S, Horie K, Furihata M, Kubota K (2003) Laparoscopic resection of the pancreas and review of the literature. Surg Endosc Other Intervent Tech 17: 201–206Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • M. D’Angelica
    • 1
  • C. Are
    • 1
  • W. Jarnagin
    • 1
  • G. DeGregoris
    • 1
  • D. Coit
    • 1
  • D. Jaques
    • 1
  • M. Brennan
    • 1
  • Y. Fong
    • 1
  1. 1.Department of SurgeryMemorial Sloan Kettering Cancer CentreUnited States

Personalised recommendations