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Surgical Endoscopy

, Volume 32, Issue 4, pp 2149–2150 | Cite as

Tips and tricks of splenic vessel preservation during laparoscopic distal pancreatectomy

  • Claire Goumard
  • Satoshi Ogiso
  • Masayuki Okuno
  • Jason B. Fleming
  • Michael Kim
  • Ching-Wei D. Tzeng
  • Jean-Nicolas Vauthey
  • Jeffrey E. Lee
  • Claudius ConradEmail author
Video
  • 203 Downloads

Abstract

Background

While a laparoscopic approach can minimize postoperative morbidity in splenic vessel preserving (SVP) distal pancreatectomy (DP), this procedure can be technically challenging. A systematic approach to SVP minimizes the chances of vascular injury and maximizes the chances of successful splenic preservation. This video demonstrates a laparoscopic DP with SVP, highlighting technical tips and tricks that optimize the chances for SVP.

Patient

The patient is a 14-year-old male with an incidentally discovered pancreatic tail mass. CT imaging demonstrates a 4.5 cm well-circumscribed tumor with the typical solid and cystic components of a solid pseudopapillary tumor (SPPT). Since SPPT is a rare pancreatic tumor associated with excellent prognosis following surgery, upfront minimally invasive DP with SPV was considered the optimal approach in this young patient. Following successful surgery, the postoperative course was uneventful. Pathology confirmed the diagnosis of a pT3N0. SPPT with negative margins.

Technique

Here we demonstrate a systematic approach to maximize the changes of SVP in DP. This approach, as demonstrated in the video, includes optimal patient and port positioning, dissection to optimize exposure of the distal splenic vessels, techniques to minimize vascular trauma especially splenic venous trauma, as well as supplemental measures to ensure postoperative patency of splenic vessels following completion of the case.

Conclusions

This systematic approach may maximize the changes of successful SVP, while avoiding postoperative complications such as splenic infarct, left-sided portal hypertension or overwhelming post-splenectomy sepsis.

Keywords

Laparoscopy Distal pancreatectomy Splenic preservation Splenic vessels preservation Vessel dissection Solid pseudopapillary tumor 

Supplementary material

Supplementary material 1 (MP4 221994 kb)

References

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Claire Goumard
    • 1
  • Satoshi Ogiso
    • 2
  • Masayuki Okuno
    • 1
  • Jason B. Fleming
    • 1
  • Michael Kim
    • 1
  • Ching-Wei D. Tzeng
    • 1
  • Jean-Nicolas Vauthey
    • 1
  • Jeffrey E. Lee
    • 1
  • Claudius Conrad
    • 1
    • 3
    Email author
  1. 1.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Division of Hepato-Biliary-Pancreatic surgery and Transplantation, Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
  3. 3.Department of Surgical OncologyHepato-Pancreato-Biliary SurgeryHoustonUSA

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