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Lee O, Yoon SK, Yoon SJ, Kim H, Han IW, Heo JS, Shin SH. Fate of small remnant pancreatic tail in splenic hilum after laparoscopic spleen preserving distal pancreatectomy: a retrospective study. Ann Surg Treat Res 2024; 106:211-217. [PMID: 38586554 PMCID: PMC10995840 DOI: 10.4174/astr.2024.106.4.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose When performing laparoscopic spleen-preserving distal pancreatectomy (LSPDP), sometimes, anatomically challenging patients are encountered, where the pancreatic tail is deep in the splenic hilum. The purpose of this study was to discuss the experience with the surgical technique of leaving the deep pancreatic tail of the splenic hilum in these patients. Methods Eleven patients who underwent LSPDP with remnant pancreatic tails between November 2019 and August 2021 at Samsung Medical Center in Seoul, Korea were included in the study. Their short-term postoperative outcomes were analyzed retrospectively. Results The mean operative time was 168.6 ± 26.0 minutes, the estimated blood loss was 172.7 ± 95.8 mL, and the postoperative length of stay was 6.1 ± 1.0 days. All 11 lesions were in the body or tail of the pancreas and included 2 intraductal papillary mucinous neoplasms, 6 neuroendocrine tumors, 2 cystic neoplasms, and 1 patient with chronic pancreatitis. In 10 of the 11 patients, only the pancreatic tail was left inside the distal portion of the splenic hilum of the branching splenic vessel, and there was a collection of intraabdominal fluid, which was naturally resolved. One patient with a remnant pancreatic tail above the hilar vessels was readmitted due to a postoperative pancreatic fistula with fever and underwent internal drainage. Conclusion In spleen preservation, leaving a small pancreatic tail inside the splenic hilum is feasible and more beneficial to the patient than performing splenectomy in anatomically challenging patients.
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Affiliation(s)
- Okjoo Lee
- Division of Hepatobiliary-pancreatic Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - So Kyung Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - So Jeong Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hongbeom Kim
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Laparoscopic distal pancreatectomy and open distal pancreatectomy: a nonrandomized comparative study. Surg Laparosc Endosc Percutan Tech 2009; 18:340-3. [PMID: 18716530 DOI: 10.1097/sle.0b013e3181705d23] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although laparoscopic distal pancreatectomy (LDP) is technically feasible, its benefits remain uncertain. The purpose of this study was to compare the clinical results of LDP and open distal pancreatectomy (ODP). The medical records of 14 consecutive patients who underwent LDP were reviewed and compared with those of 19 patients who underwent ODP. All patients were treated for benign or borderline malignant disease of the pancreas. Operation time was longer for LDP than for ODP (290.7 vs. 213.8 min, P=0.0022), and postoperative analgesics were administered less frequently for patients who underwent LDP. Patients treated by LDP had earlier recovery of bowel function, shorter time to oral intake, and shorter postoperative hospital stay than those treated by ODP. No difference in morbidity or inflammatory response was observed between the 2 groups. LDP for benign or borderline malignant disease of the pancreas provides benefits without increasing morbidity.
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Pancreatic Tail Cysts. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Castillo O, Kerkebe M, Vitagliano G, Arellano L. [Single-stage laparoscopic adrenalectomy and pancreatic cyst exsicion in a patient with von Hippel-Lindau disease]. Actas Urol Esp 2007; 31:292-4. [PMID: 17658161 DOI: 10.1016/s0210-4806(07)73638-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Von Hippel-Lindau disease is a dominant autosomic hereditary condition, characterized by cerebellar hemangioblastomas, retinal animas and visceral cysts and tumors. We report a case of a patient with Von Hippel-Lindau in which we performed a single-stage laparoscopic adrenalectomy for a pheochromocytoma and pancreatic cyst excision. PATIENT AND METHOD A 20 year old male patient with Von Hippel Lindau disease underwent laparoscopic adrenalectomy for a 5 cm left adrenal mass. A 3 cm cystic lesion was found of the tail of the pancreas and was resected completely laparoscopically during the same operative procedure. RESULTS Total operative time was 120 minutes. There were no operative or postoperative complications. Blood loss was < 50 mL and hospital stay was 3 days. The histopathologic result was adrenal pheochromocytoma and pancreatic mucous microcystic cystoadenoma. CONCLUSION Laparoscopy allows surgical approach of patients with simultaneous lesions in several abdominal solid viscera, like Von Hippel Lindau disease. This case represents the first report of one-stage laparoscopic adrenalectomy and pancreatic cyst excision.
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Affiliation(s)
- O Castillo
- Unidad de Endourología y Laparoscopia Urológica Clínica Santa María, Universidad de Chile.
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Takaori K, Tanigawa N. Laparoscopic pancreatic resection: the past, present, and future. Surg Today 2007; 37:535-45. [PMID: 17593471 DOI: 10.1007/s00595-007-3472-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 01/11/2007] [Indexed: 02/06/2023]
Abstract
Since the early 1990s, laparoscopic techniques have been applied to a growing number of pancreatic surgeries. Laparoscopic pancreatic resections have been performed in patients with a variety of diseases including chronic pancreatitis, pancreatic trauma, congenital hyperinsulinism, and neoplasms of the pancreas; e.g., insulinoma, mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, etc. Laparoscopic pancreatic resections with an en bloc lymph node dissection have also been performed for invasive carcinomas. The long-term results after laparoscopic resections for invasive pancreatic cancer, however, are still not well defined. Laparoscopic distal pancreatectomies with or without spleen preservation may benefit patients with reduced postoperative pain, shorter hospital stay, a quicker recovery to normal activity, and better cosmetic appearances based on retrospective analyses of collective series and case reports. Prospective randomized controlled trials are needed to validate these benefits. In contrast, laparoscopic proximal pancreatectomies with or without duodenum preservation remain controversial. Although a laparoscopic pancreaticoduodenectomy and laparoscopic duodenum-preserving pancreatic head resection are technically feasible, laparoscopic reconstruction after proximal pancreatectomies is not yet generally practicable but limited to personal experiences by highly skilled endoscopic surgeons. To justify the performance of laparoscopic proximal pancreatectomies, it is mandatory to demonstrate the potential clinical benefits and safety of these complicated procedures.
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Affiliation(s)
- Kyoichi Takaori
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
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Aluka KJ, Long C, Rickford MS, Turner PL, McKenna SJ, Fullum TM. Laparoscopic distal pancreatectomy with splenic preservation for serous cystadenoma: a case report and literature review. Surg Innov 2007; 13:94-101. [PMID: 17012149 DOI: 10.1177/1553350606291339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A minimally invasive approach can be beneficial in a spleen-preserving distal pancreatectomy. This article reports a 71-year-old woman who presented to her internist with hypertension and persistent hypokalemia. A computed tomography scan to rule out a functional adrenal mass incidentally revealed a 4 cm x 3 cm x 2 cm serous cystadenoma of the distal pancreas and normal adrenal glands. The patient was referred to the general surgery service for resection of the distal pancreatic lesion. A laparoscopic spleen-preserving distal pancreatectomy was performed. The lesion was completely excised, and the pathology revealed serous cystadenoma with focal fibrosis and atrophic acini. The postoperative advantages of this approach were the early return of bowel function, minimal narcotic requirements, and early resumption of normal activities. This case illustrates the advantages of minimally invasive surgery in the performance of a spleen-preserving distal pancreatectomy.
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Affiliation(s)
- Kanayochukwu J Aluka
- Department of Surgery, Providence Hospital, Washington, District of Columbia, USA.
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Root J, Nguyen N, Jones B, Mccloud S, Lee J, Nguyen P, Chang K, Lin P, Imagawa D. Laparoscopic Distal Pancreatic Resection. Am Surg 2005. [DOI: 10.1177/000313480507100910] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Laparoscopic resection is not an established treatment for pancreatic tumors. Previous reports, mainly in Europe and Japan, have demonstrated the potential utility of laparoscopic distal pancreatectomy (LDP). However, few reports have been published from the United States. We instituted a pilot program to assess LDP. A total of 11 patients were included from December 2003 to December 2004. All patients were staged with preoperative endoscopic ultrasound and received vaccinations for possible splenectomy. The indications for surgery were as follows: neuroendocrine tumor (n = 7), unspecified tumor (n = 1), and cystic neoplasm (n = 3). All procedures began with diagnostic laparoscopy and intraoperative ultrasound. Three patients underwent laparoscopic enucleation of a discrete pancreatic nodule. In eight patients, LDP was attempted. One patient required conversion to an open procedure. In the other seven patients, the procedure was completed laparoscopically, two with hand-assist. The average operative time was 5 hours and 3 minutes; average length of stay was 5 days; and the splenectomy rate was 57 per cent (n = 4). There was one complication of an infected hematoma. There were no pancreatic leaks, deaths, nor readmissions. LDP with or without splenectomy is feasible and can be performed with minimum morbidity and only slightly increased operative time.
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Affiliation(s)
- Jeff Root
- Division of Hepatobiliary and Pancreatic Surgery, UC Irvine Medical Center, Orange, California
| | - Ninh Nguyen
- Division of Gastrointestinal Surgery, UC Irvine Medical Center, Orange, California
| | - Blanding Jones
- Division of Hepatobiliary and Pancreatic Surgery, UC Irvine Medical Center, Orange, California
| | - Scott Mccloud
- Department of Radiology, UC Irvine Medical Center, Orange, California
| | - John Lee
- Division of Gastrointestinal Medicine, Chao Comprehensive Digestive Disease Center, UC Irvine Medical Center, Orange, California
| | - Phuong Nguyen
- Division of Gastrointestinal Medicine, Chao Comprehensive Digestive Disease Center, UC Irvine Medical Center, Orange, California
| | - Ken Chang
- Division of Gastrointestinal Medicine, Chao Comprehensive Digestive Disease Center, UC Irvine Medical Center, Orange, California
| | - Peter Lin
- Division of Hepatobiliary and Pancreatic Surgery, UC Irvine Medical Center, Orange, California
| | - David Imagawa
- Division of Hepatobiliary and Pancreatic Surgery, UC Irvine Medical Center, Orange, California
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Abstract
Advances in minimally invasive surgery have revolutionized the field of surgery. Despite the great strides in equipment and experience, operative conduct remains confined by the limits of exposure. Retroperitoneal fat can be abundant and can contribute greatly to difficulty in exposure. Visceral organs ventral to the retroperitoneum preclude direct access and require optimal patient positioning to operate. Additionally, the major vascular pedicles all originate in the retroperitoneum off of the abdominal aorta or enter the inferior vena cava. The pancreas, in particular, is surrounded by the portal vein, celiac axis, superior mesenteric vein and artery, and splenic vein and artery. If injured during surgery, these vessels can present a life-threatening emergency. The issues related to the vasculature, coupled with the difficulty in resecting portions of the pancreas and the relative paucity of pancreatic procedures, have greatly concentrated these cases at tertiary care centers staffed by experienced laparoscopists. However, as surgical technology improves and fellowships train more surgeons with advanced laparoscopic skills, minimally invasive pancreatic surgery may diffuse with more community-based health care networks.
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Affiliation(s)
- Daniel Tseng
- Department of Surgery, Oregon Health and Science University, Portland, Oregon 97201, USA
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Mabrut JY, Boulez J, Peix JL, Gigot JF, Gouillat C, De La Roche E, Adham M, Ducerf C, Baulieux J. [Laparoscopic pancreatic resections]. ACTA ACUST UNITED AC 2003; 128:425-32. [PMID: 14559190 DOI: 10.1016/s0003-3944(03)00181-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The feasibility of laparoscopic pancreatic resection has been demonstrated. However, the real clinical benefit for the patients remains questioned. The best indication for a laparoscopic approach appears to be the resection of benign or neuro-endocrine tumors without a need for pancreato-enteric reconstruction (i.e enucleation or distal pancreatectomy). The use of the laparoscopic approach for malignant tumors still remains controversial. The benefits of minimally invasive surgery are clearly correlated with the successful management of the pancreatic stump. Pancreatic related complication rate (fistula and collection) is 15% when using pancreatic transection with a laparoscopic endostappler.
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Affiliation(s)
- J-Y Mabrut
- Service de chirurgie générale, digestive et de la transplantation hépatique, hôpital de la Croix-Rousse, 103, Grande rue de la Croix-Rousse, 69317 Lyon 04, France.
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Hand-assisted laparoscopic distal pancreatectomy with minilaparotomy for distal pancreatic cystadenoma. Surg Laparosc Endosc Percutan Tech 2001. [PMID: 11330382 DOI: 10.1097/00129689-200104000-00016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Two patients with cystic tumors of the pancreas treated by laparoscopic distal pancreatectomy are presented. The first patient was a 34-year-old woman with a 6-cm cystadenoma of the tail of the pancreas treated with a complete laparoscopic distal pancreatectomy. After mobilization of the distal pancreas and spleen, the pancreas was transected proximally together with the splenic artery and vein using an endoscopic linear stapler. The second patient was a 71-year-old woman with a 6-cm cystadenoma of the body of the pancreas, treated by hand-assisted laparoscopic distal pancreatectomy with minilaparotomy because the tumor was adjacent to the portal vein and celiac axis. Using an upper median minilaparotomy, dissection of the gastrocolic ligament, division of the splenic artery, and transection and closure of the pancreas were performed. Division of the splenic vein and mobilization of the distal pancreas and spleen were performed via a hand-assisted laparoscopic approach. There were no postoperative complications (such as pancreatic fistulas) in either patient, and the postoperative courses were uneventful. The patients returned to normal activity within 1 week after the operation. Complete laparoscopic and hand-assisted laparoscopic distal pancreatectomy are preferable to conventional open surgery for benign tumors of the pancreas because of their less-invasive nature. Additionally, in tumors of the body of the pancreas, hand-assisted laparoscopic distal pancreatectomy might have the advantages of laparotomy and laparoscopy in terms of handling the splenic artery and vein just below the minilaparotomy site, suggesting an easier and safer procedure than complete laparoscopic distal pancreatectomy. Therefore, hand-assisted laparoscopic distal pancreatectomy can be recommended as a useful alternative to complete laparoscopic distal pancreatectomy for selected patients with benign tumors of the body and tail of the pancreas.
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Furihata M, Tagaya N, Kubota K. Laparoscopic enucleation of insulinoma in the pancreas: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 2001; 11:279-83. [PMID: 11525376 DOI: 10.1097/00129689-200108000-00011] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a case of islet cell tumor of the pancreas managed by laparoscopic surgery. A 27-year-old woman was admitted to the hospital after fainting from hypoglycemia. Diagnostic imaging showed a small tumor 1 cm in diameter in the body of the pancreas. Laparoscopic enucleation of the tumor was performed with laparoscopic coagulating shears. The operation time was 210 minutes, and there were no perioperative complications such as pancreatic leakage. The postoperative course was uneventful, and the patient was discharged from the hospital on the seventh postoperative day. The histopathologic diagnosis was insulin-producing islet cell tumor. This method is technically feasible and safe for the management of small islet cell tumors located on the surface of the pancreas.
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Affiliation(s)
- M Furihata
- Second Department of Surgery, Dokkyo University School of Medicine, Mibu, Tochigi, Japan
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14
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Burpee S, Jossart G, Gagner M. The laparoscopic approach to gastroenteropancreatic tumors. ACTA ACUST UNITED AC 1999. [DOI: 10.1007/bf02620165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Takabatake I, Miyanaga T, Yokoyama K, Yoshida C. Laparoscopic distal pancreatic resection for solid cystic tumour. MINIM INVASIV THER 1999. [DOI: 10.3109/13645709909153188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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