Surgical Endoscopy

, Volume 25, Issue 8, pp 2643–2649 | Cite as

Laparoscopic approach to distal and subtotal pancreatectomy: a clockwise technique

  • Horacio J. Asbun
  • John A. Stauffer



Laparoscopic surgery is becoming a more widely used approach for benign and malignant lesions in the neck, body, and tail of the pancreas. Recent literature reports appear to demonstrate that laparoscopic distal pancreatectomy (LDP) has clear benefits compared with open distal pancreatectomy (ODP). However, the procedure is relatively new and in some patients may remain a technically demanding operation.


Twenty-nine LDPs were performed by a single surgeon during the course of 12 months by using a multistep clockwise technique described in detail below. The technique appears to simplify and standardize the approach for both the simpler and the more difficult procedure. Retrospective analysis was performed regarding perioperative outcomes.


Twenty-three procedures were performed for a neoplastic process with five patients having pancreatic adenocarcinoma. There was no conversion to ODP, but one patient required a hand-assist method. Splenectomy was performed in 26 patients. Median operative time, estimated blood loss, and length of stay was 182 min, 50 ml, and 4 days respectively. Overall morbidity and pancreatic fistula rate was 17.2% and 10.3%, respectively. Median number of lymph nodes was 14, concomitant left adrenalectomy was performed in 3 patients, and margins were negative in 28 patients.


LDP has been shown to be an acceptable approach to both benign and malignant disease of the distal pancreas. The technique used in this manuscript appears to facilitate a reliable and safe five-step method to perform this procedure and ensures that appropriate oncologic principles are followed through each step. Even though this is a small feasibility series focused on surgical technique, our results appear to demonstrate an acceptable pancreatic leak rate.


Laparoscopic Distal pancreatectomy Pancreatic ductal adenocarcinoma Pancreatectomy 



Laparoscopic distal pancreatectomy


Open distal pancreatectomy


Intraductal papillary mucinous neoplasm


Radical antegrade modular pancreatospenectomy


Eastern Cooperative Oncology Group



Drs. John A. Stauffer and Horacio J. Asbun have no conflicts of interest or financial ties to disclose.


  1. 1.
    Melotti G, Butturini G, Piccoli M, Casetti L, Bassi C, Mullineris B, Lazzaretti MG, Pederzoli P (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246(1):77–82PubMedCrossRefGoogle Scholar
  2. 2.
    Palanivelu C, Shetty R, Jani K, Sendhilkumar K, Rajan PS, Maheshkumar GS (2007) Laparoscopic distal pancreatectomy: results of a prospective non-randomized study from a tertiary center. Surg Endosc 21(3):373–377PubMedCrossRefGoogle Scholar
  3. 3.
    Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW, Lee SK, Kim MH, Han DJ (2008) Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc 22(10):2261–2268PubMedCrossRefGoogle Scholar
  4. 4.
    Fernández-Cruz L, Cosa R, Blanco L, Levi S, López-Boado MA, Navarro S (2007) Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg 11(12):1607–1621; discussion 1621–1622PubMedCrossRefGoogle Scholar
  5. 5.
    Taylor C, O’Rourke N, Nathanson L, Martin I, Hopkins G, Layani L, Ghusn M, Fielding G (2008) Laparoscopic distal pancreatectomy: the Brisbane experience of forty-six cases. HPB (Oxford) 10(1):38–42Google Scholar
  6. 6.
    Laxa BU, Carbonell AM II, Cobb WS, Rosen MJ, Hardacre JM, Mekeel KL, Harold KL (2008) Laparoscopic and hand-assisted distal pancreatectomy. Am Surg 74(6):481–486; discussion 486–487PubMedGoogle Scholar
  7. 7.
    Pryor A, Means JR, Pappas TN (2007) Laparoscopic distal pancreatectomy with splenic preservation. Surg Endosc 21(12):2326–2330PubMedCrossRefGoogle Scholar
  8. 8.
    Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL, Gigot JF (2005) Hepatobiliary and Pancreatic Section (HBPS) of the Royal Belgian Society of Surgery; Belgian Group for Endoscopic Surgery (BGES); Club Coelio. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137(6):597–605Google Scholar
  9. 9.
    Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, Parikh AA, Martin RC II, Scoggins CR, Ahmad S, Kim HJ, Park J, Johnston F, Strouch MJ, Menze A, Rymer J, McClaine R, Strasberg SM, Talamonti MS, Staley CA, McMasters KM, Lowy AM, Byrd-Sellers J, Wood WC, Hawkins WG (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248(3):438–446PubMedGoogle Scholar
  10. 10.
    Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, Sellers JB, Merchant NB, Scoggins CR, Martin RC III, Kim HJ, Ahmad S, Cho CS, Parikh AA, Chu CK, Hamilton NA, Doyle CJ, Pinchot S, Hayman A, McClaine R, Nakeeb A, Staley CA, McMasters KM, Lillemoe KD (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210(5):779–785, 786–787Google Scholar
  11. 11.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition [review]. Surgery 138(1):8–13PubMedCrossRefGoogle Scholar
  12. 12.
    DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244(6):931–937; discussion 937–939PubMedCrossRefGoogle Scholar
  13. 13.
    Velanovich V (2006) The lasso technique for laparoscopic distal pancreatectomy. Surg Endosc 20(11):1766–1771PubMedCrossRefGoogle Scholar
  14. 14.
    Strasberg SM, Linehan DC, Hawkins WG (2007) Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tail of the pancreas: ability to obtain negative tangential margins. J Am Coll Surg 204(2):244–249PubMedCrossRefGoogle Scholar
  15. 15.
    Kang CM, Kim DH, Lee WJ (2010) Ten years of experience with resection of left-sided pancreatic ductal adenocarcinoma: evolution and initial experience to a laparoscopic approach. Surg Endosc 24(7):1533–1541PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Division of General SurgeryMayo ClinicJacksonvilleUSA

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