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Laparoscopic distal pancreatectomy

Results of a prospective non-randomized study from a tertiary center

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Abstract

Background

Though laparoscopic distal pancreatectomy for benign conditions was first described in the early 1990s, it has not become as popular as other laparoscopic surgeries. Published literature on this topic consists of several case reports and a handful of small series. We present our experience, which, to the best of our knowledge, is the largest series reported to date.

Methods

Since 1998, 22 patients have undergone distal pancreatectomy at our institute. The technique of distal pancreatosplenectomy, as well as spleen-preserving distal pancreatectomy, is described.

Results

Four males and 18 females in the age range of 12–69 years underwent operation. Splenic preservation was possible in 7 patients. The tumor diameter ranged from 2.1 cm to 7.4 cm. The mean operating time was 215 min. The mean length of incision required for specimen retrieval was 3.4 cm. All patients were started on a liquid diet on the first postoperative day. The median hospital stay was 4 days. One patient developed a pancreatic fistula that was managed conservatively. At the end of an average follow-up of 4.6 years, no recurrence has been reported.

Conclusions

Laparoscopic distal pancreatectomy is a safe procedure, with minimal morbidity, rapid recovery, and short hospital stay. In appropriate cases, splenic preservation is feasible.

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References

  1. 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 188:255–260

    Article  PubMed  CAS  Google Scholar 

  2. Berends FJ, Cuesta MA, Kazemier G, van Eijck CH, de Herder WW, van Muiswinkel JM, Bruining HA, Bonjer HJ (2000) Laparoscopic detection and resection of insulinomas. Surgery 128:386–391

    Article  PubMed  CAS  Google Scholar 

  3. Boukhman MP, Karam JM, Shaver J, Siperstein AE, DeLorimer AA, Clark OH (1999) Localization of insulinomas. Arch Surg 134:818–823

    Article  PubMed  CAS  Google Scholar 

  4. Cushieri A, Jakimowicz JJ, van Spreeuwel J (1996) Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg 223:280–285

    Article  Google Scholar 

  5. Dexter SP, Martin IG, Leindler L, Fowler R, McMahon MJ (1999) Laparoscopic enucleation of a solitary pancreatic insulinoma. Surg Endosc 13:406–408

    Article  PubMed  CAS  Google Scholar 

  6. Doi R, Ito D, Fujimoto K, Komoto I, Ohta Y, Torii M, Imamura M (2003) Hand-assisted laparoscopic resection of serous cystadenoma of the pancreas. Surg Endosc 17:2028–2031

    Article  PubMed  CAS  Google Scholar 

  7. Edwin B, Mala T, Mathisen Ø, Gladhaug I, Buanes T, Lunde OC, Søreide O, Bergan A, Fosse E (2004) Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg Endosc 18:407–411

    Article  PubMed  CAS  Google Scholar 

  8. 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 8:493–501

    Article  PubMed  Google Scholar 

  9. Gagner M, Pomp A, Herrera M (1996) Early experience with laparoscopic resections of islet cell tumours. Surgery 120:1051–1054

    Article  PubMed  CAS  Google Scholar 

  10. Govil S, Imrie CW (2000) Value of splenic preservation during distal pancreatectomy for chronic pancreatitis. Br J Surg 86:895–898

    Article  Google Scholar 

  11. Han HS, Min SK, Lee HK, Kim S-W, Park Y-H (2005) Laparoscopic distal pancreatectomy with preservation of the spleen and splenic vessels for benign pancreas neoplasm. Surg Endosc 19:1367–1369

    Article  PubMed  Google Scholar 

  12. Kano N, Kusanagi H, Yamada S, Kasama K, Ota A (2002) Laparoscopic pancreatic surgery: its indications and techniques: from the viewpoint of limiting the indications. J Hepatobiliary Pancreat Surg 9:555–558

    Article  PubMed  Google Scholar 

  13. Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Oitt HA, Yeo CJ (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229:693–698

    Article  PubMed  CAS  Google Scholar 

  14. Lo CY, Lo CM, Fan ST (2000) Role of laparoscopic ultrasonography in intraoperative localization of pancreatic insulinoma. Surg Endosc 14:1131–1135

    Article  PubMed  CAS  Google Scholar 

  15. Lo CY, Lo CM, Fan ST (2000) Role of laparoscopic ultrasonography in intraoperative localization of pancreatic insulinoma. Surg Endosc 14:1131–1135

    Article  PubMed  CAS  Google Scholar 

  16. Molina WR, Desai MM, Ng CS, Spaliviero M, Gill IS (2004) Retroperitoneoscopic radical nephrectomy with concomitant distal pancreatectomy: case report. J Endourol 18:665–667

    Article  PubMed  Google Scholar 

  17. Patterson EJ, Gagner M, Salky B, Inabet 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 193:281–287

    Article  PubMed  CAS  Google Scholar 

  18. Proye C, Malvaux P, Pattou F, Filoche B, Godchaux JM, Maunoury V, Palazzo L, Huglo D, Lefebvre J, Paris JC (1998) Noninvasive imaging of insulinomas and gastrinomas with endoscopic ultrasonography and somatostatin receptor scintigraphy. Surgery 124:1134–1143

    Article  PubMed  CAS  Google Scholar 

  19. Rattner WR, Fernandez-del Castillo, Warshaw AL (1996) Pitfalls of distal pancreatectomy for relief of pain in chronic pancreatitis. Am J Surg 171:142–146

    Article  PubMed  CAS  Google Scholar 

  20. Salky BA, Edye M (1996) Laparoscopic pancreatectomy. Surg Clin North Am 76:539–545

    Article  PubMed  CAS  Google Scholar 

  21. Shimizu S, Tanaka M, Konomi H, Tamura T, Mizumoto K, Yamaguchi K (2004) Spleen-preserving laparoscopic distal pancreatectomy after division of the splenic vessels. J Laparoendosc Adv Surg Tech A 14:173–177

    Article  PubMed  Google Scholar 

  22. Shimizu S, Tanaka M, Konomi H, Mizumoto K, Yamaguchi K (2004) Laparoscopic pancreatic surgery: current indications and surgical results. Surg Endosc 18:402–406

    Article  PubMed  CAS  Google Scholar 

  23. 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 11:139–143

    Article  PubMed  CAS  Google Scholar 

  24. Sledzianowski JF, Duffas JP, Muscari F, Suc B, Fourtanier F (2005) Risk factors for mortality and intra-abdominal morbidity after distal pancreatectomy. Surgery 137:180–185

    Article  PubMed  CAS  Google Scholar 

  25. Soper NJ, Brunt LM, Dunnegan DL, Meininger TA (1994) Laparoscopic distal pancreatectomy in the porcine model. Surg Endosc 8:57–61

    Article  PubMed  CAS  Google Scholar 

  26. Sussman LA, Christie R, Whittle DE (1996) Laparoscopic excision of distal pancreas including insulinoma. Aust N Z J Surg 66:414–416

    PubMed  CAS  Google Scholar 

  27. Takada M, Ichihara T, Toyama H, Suzuki Y, Kuroda Y (2004) Retroperitoneoscopic laparoscopic distal pancreatectomy with spleen salvage. Hepato-gastroenterology 2004 51:925–927

    Google Scholar 

  28. Ueno T, Oka M, Nishihara K, Yamamoto K, Nakamura M, Yahara N, Adachi T (1999) Laparoscopic distal pancreatectomy with preservation of the spleen. Surg Laparosc Endosc Percutan Tech 9:290–293

    Article  PubMed  CAS  Google Scholar 

  29. Vezakis A, Davides D, Larvin M, McMahon MJ (1999) Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg Endosc 13:26–29

    Article  PubMed  CAS  Google Scholar 

  30. Warshaw AL (1998) Conservation of the spleen with distal pancreatectomy. Arch Surg 123:550–553

    Google Scholar 

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Correspondence to K. Jani.

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Palanivelu, C., Shetty, R., Jani, K. et al. Laparoscopic distal pancreatectomy. Surg Endosc 21, 373–377 (2007). https://doi.org/10.1007/s00464-006-9020-z

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  • DOI: https://doi.org/10.1007/s00464-006-9020-z

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