Surgical Endoscopy

, Volume 33, Issue 1, pp 88–93 | Cite as

True learning curve of laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation

  • Hyung Sun Kim
  • Joon Seong ParkEmail author
  • Dong Sup Yoon



Laparoscopic distal pancreatectomy (LDP) is generally the treatment of choice for diseases of the pancreatic body and tail. Most surgeons prefer the spleen- and splenic vessel-preserving technique (SPVP-LDP) in benign/borderline pancreatic disease because complications of splenic infarction and gastric varices can arise after Warshaw technique. This study was aimed to determine the true learning curve of the SPVP-LDP procedure not LDP including Warshaw technique.


Data were collected retrospectively from all patients who underwent a LDP between June 2007 and April 2017 at Gangnam Severance Hospital. We used cumulative sum control chart (CUSUM) analysis to assess the learning curve for the SPVP-LDP technique.


Eight-three patients were performed LDP and we excluded patients who underwent robotic approach (N = 10) and open conversion DP (N = 8). Patients who underwent SPVP-LDP procedures were categorized into Group 1 (primary end-point). Those who underwent LDP procedures with splenectomy and the Warshaw technique were categorized into Group 2. We found that the 16th case was the cutoff point and the mean length of hospital stay was 13.0 days in the first period and 8.7 days in the second period (p = < 0.001).


These results indicated that the frequency of SPVP-LDPs had increased and that technological progress had been made over time. The true learning curve for SPVP-LDP was indicated as 16 cases in a group of surgeons with no experience of laparoscopic pancreatic surgery.


Laparoscopic pancreatic surgery Splenic preservation Learning curve 


Compliance with ethical standards


Hyung Sun Kim, Joon Seong Park, and Dong Sup Yoon have no conflicts of interest or financial ties to disclose.


  1. 1.
    Nigri GR, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M (2011) Metaanalysis of trials comparing minimally invasive and open distal pancreatectomies. Surg Endosc 25(5):1642–1651CrossRefGoogle Scholar
  2. 2.
    Song KB, Kim SC, Park JB, Kim YH, Jung YS, Kim MH, Lee SK, Seo DW, Lee SS, Park DH et al (2011) Single-center experience of laparoscopic left pancreatic resection in 359 consecutive patients: changing the surgical paradigm of left pancreatic resection. Surg Endosc 25(10):3364–3372CrossRefGoogle Scholar
  3. 3.
    Yoon YS, Lee KH, Han HS, Cho JY, Jang JY, Kim SW, Lee WJ, Kang CM, Park SJ, Han SS et al (2015) Effects of laparoscopic versus open surgery on splenic vessel patency after spleen and splenic vessel-preserving distal pancreatectomy: a retrospective multicenter study. Surg Endosc 29(3):583–588CrossRefGoogle Scholar
  4. 4.
    Ferrone CR, Konstantinidis IT, Sahani DV, Wargo JA, Fernandez-del Castillo C, Warshaw AL (2011) Twenty-three years of the Warshaw operation for distal pancreatectomy with preservation of the spleen. Ann Surg 253(6):1136–1139CrossRefGoogle Scholar
  5. 5.
    Carrere N, Abid S, Julio CH, Bloom E, Pradere B (2007) Spleen-preserving distal pancreatectomy with excision of splenic artery and vein: a case-matched comparison with conventional distal pancreatectomy with splenectomy. World J Surg 31(2):375–382CrossRefGoogle Scholar
  6. 6.
    Louis D, Alassiri A, Kirzin S, Blaye-Felice S, Chalret du Rieu M, Julio CH, Bloom E, Ghouti L, Pradere B, Portier G et al (2017) Gastric bleeding risk following spleen preserving distal pancreatectomy with excision of the splenic vessels: a long-term follow-up. HPB (Oxford) 19(4):345–351CrossRefGoogle Scholar
  7. 7.
    Butturini G, Inama M, Malleo G, Manfredi R, Melotti GL, Piccoli M, Perandini S, Pederzoli P, Bassi C (2012) Perioperative and long-term results of laparoscopic spleen-preserving distal pancreatectomy with or without splenic vessels conservation: a retrospective analysis. J Surg Oncol 105(4):387–392CrossRefGoogle Scholar
  8. 8.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefGoogle Scholar
  9. 9.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13CrossRefGoogle Scholar
  10. 10.
    Park JS, Lee DH, Jang JY, Han Y, Yoon DS, Kim JK, Han HS, Yoon Y, Hwang D, Kang CM et al (2016) Use of TachoSil((R)) patches to prevent pancreatic leaks after distal pancreatectomy: a prospective, multicenter, randomized controlled study. J Hepatobiliary Pancreat Sci 23(2):110–117CrossRefGoogle Scholar
  11. 11.
    Sahakyan MA, Kazaryan AM, Rawashdeh M, Fuks D, Shmavonyan M, Haugvik SP, Labori KJ, Buanes T, Rosok BI, Ignjatovic D et al (2016) Laparoscopic distal pancreatectomy for pancreatic ductal adenocarcinoma: results of a multicenter cohort study on 196 patients. Surg Endosc 30(8):3409–3418CrossRefGoogle Scholar
  12. 12.
    Joliat GR, Demartines N, Halkic N, Petermann D, Schafer M (2017) Short-term outcomes after distal pancreatectomy: laparotomy vs. laparoscopy: a single-center series. Ann Med Surg (Lond) 13:1–5CrossRefGoogle Scholar
  13. 13.
    Anderson KL Jr, Adam MA, Thomas S, Roman SA, Sosa JA (2017) Impact of minimally invasive vs. open distal pancreatectomy on use of adjuvant chemoradiation for pancreatic adenocarcinoma. Am J Surg 213(4):601–605CrossRefGoogle Scholar
  14. 14.
    Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, Fabre JM, Boulez J, Baulieux J, Peix JL et al (2005) Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery 137(6):597–605CrossRefGoogle Scholar
  15. 15.
    Bruzoni M, Sasson AR (2008) Open and laparoscopic spleen-preserving, splenic vessel-preserving distal pancreatectomy: indications and outcomes. J Gastrointest Surg 12(7):1202–1206CrossRefGoogle Scholar
  16. 16.
    Sato Y, Shimoda S, Takeda N, Tanaka N, Hatakeyama K (2000) Evaluation of splenic circulation after spleen-preserving distal pancreatectomy by dividing the splenic artery and vein. Dig Surg 17(5):519–522CrossRefGoogle Scholar
  17. 17.
    Miura F, Takada T, Asano T, Kenmochi T, Ochiai T, Amano H, Yoshida M (2005) Hemodynamic changes of splenogastric circulation after spleen-preserving pancreatectomy with excision of splenic artery and vein. Surgery 138(3):518–522CrossRefGoogle Scholar
  18. 18.
    Tien YW, Liu KL, Hu RH, Wang HP, Chang KJ, Lee PH (2010) Risk of varices bleeding after spleen-preserving distal pancreatectomy with excision of splenic artery and vein. Ann Surg Oncol 17(8):2193–2198CrossRefGoogle Scholar
  19. 19.
    Kim H, Song KB, Hwang DW, Lee JH, Shin SH, Jun ES, Kim SR, Kwak BJ, Kim TG, Park KM et al (2016) A single-center experience with the laparoscopic Warshaw technique in 122 consecutive patients. Surg Endosc 30(9):4057–4064CrossRefGoogle Scholar
  20. 20.
    Jeon HH, Lee HS, Youn YH, Park JJ, Park H (2016) Learning curve analysis of colorectal endoscopic submucosal dissection (ESD) for laterally spreading tumors by endoscopists experienced in gastric ESD. Surg Endosc 30(6):2422–2430CrossRefGoogle Scholar
  21. 21.
    Nachmany I, Pencovich N, Ben-Yehuda A, Lahat G, Nakache R, Goykhman Y, Lubezky N, Klausner JM (2016) Laparoscopic distal pancreatectomy: learning curve and experience in a tertiary center. J Laparoendosc Adv Surg Tech A 26(6):470–474CrossRefGoogle Scholar
  22. 22.
    Shakir M, Boone BA, Polanco PM, Zenati MS, Hogg ME, Tsung A, Choudry HA, Moser AJ, Bartlett DL, Zeh HJ et al (2015) The learning curve for robotic distal pancreatectomy: an analysis of outcomes of the first 100 consecutive cases at a high-volume pancreatic centre. HPB (Oxford) 17(7):580–586CrossRefGoogle Scholar
  23. 23.
    de Rooij T, Cipriani F, Rawashdeh M, van Dieren S, Barbaro S, Abuawwad M, van Hilst J, Fontana M, Besselink MG, Abu Hilal M (2017) Single-surgeon learning curve in 111 laparoscopic distal pancreatectomies: does operative time tell the whole story? J Am Coll Surg 224(5):826–832CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Hyung Sun Kim
    • 1
  • Joon Seong Park
    • 1
    Email author
  • Dong Sup Yoon
    • 2
  1. 1.Pancreatobiliary Cancer Clinic, Department of Surgery, Gangnam Severance HospitalYonsei UniversitySeoulSouth Korea
  2. 2.Pancreatobiliary Cancer Clinic, Department of Surgery, Severance HospitalYonsei UniversitySeoulSouth Korea

Personalised recommendations