Robotic-Assisted Laparoscopic Distal Pancreatectomy with Splenic Preservation
Distal pancreatectomy is an operation which removes the portion of the pancreas extending to the left of the superior mesenteric vein/portal vein trunk and not including the duodenum and distal bile duct. The exact boundary line of transection depends on the location of the lesion. Distal pancreatectomy includes distal pancreatectomy and splenectomy (DPS) and spleen-preserving distal pancreatectomy (SPDP). These years more and more SPDP have been reported. The rich blood supply of spleen is offered by the branches of short gastric vessels and gastroepiploic vessels, so after the ligation of the splenic vessels, the spleen blood supply of nearly 90% patients can still be maintained. Therefore, SPDP can be accomplished by either of these two ways: (1) Kimura’s procedure . The branches of splenic vessels are ligated and then the distal part of pancreas is dissected while the trunk of splenic vessels and the spleen are preserved, which, technically speaking, is more difficult and risky. (2) Warshaw technique . The splenic vessels are ligated and dissected with the left gastroepiploic vessels and the short gastric vessels being well preserved to keep the blood supply of spleen. However, it is still controversial about the advantages and disadvantages of these two procedures of SPDP. According to our clinical experience, for benign of early malignant tumors of the pancreatic body and tail, Kimura’s procedure should be the first choice. With precise manipulation during the operation, the morbidity is believed to be decreased, meaning that this procedure is safe and feasible. However, Warshaw technique is rather a substitute choice to reduce surgical risk.