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Laparoscopic left pancreatectomy with spleen preservation for a suspicion of IPMN

Laparoscopic distal pancreatectomy is suitable for benign and premalignant neoplasms located in the body and tail of the pancreas. Spleen preservation following distal pancreatectomy is known to be safe. There are two distinct approaches to preserve the spleen during the dissection of the distal pancreas. The classic design is to identify, isolate, and preserve the splenic artery and vein. Alternatively, the splenic artery and vein are ligated with the pancreas, and perfusion of the spleen is assured by the short gastric vessels. Both are accepted as appropriate techniques to address a mass in the tail of the pancreas. This video demonstrates a left pancreatic resection with spleen preservation and ligation of the splenic artery and vein.

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Laparoscopic   left   pancreatectomy   with   spleen   preservation   for   a   suspicion   of   IPMN

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Resumen
Laparoscopic distal pancreatectomy is suitable for benign and premalignant neoplasms located in the body and tail of the pancreas. Spleen preservation following distal pancreatectomy is known to be safe. There are two distinct approaches to preserve the spleen during the dissection of the distal pancreas. The classic design is to identify, isolate, and preserve the splenic artery and vein. Alternatively, the splenic artery and vein are ligated with the pancreas, and perfusion of the spleen is assured by the short gastric vessels. Both are accepted as appropriate techniques to address a mass in the tail of the pancreas. This video demonstrates a left pancreatic resection with spleen preservation and ligation of the splenic artery and vein.
Clasificación
complex cases
Palabras clave
Tipo de medio
Duración
19'27''
Publicación
2010-02
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en
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WeBSurg.com, Feb 2010;10(02).
URL: http://www.websurg.com/doi-vd01en2864.htm

Laparoscopic   left   pancreatectomy   with   spleen   preservation   for   a   suspicion   of   IPMN

12. Pancreas mobilization 13'49''
Mobilization of the pancreas is then continued on the lateral side, starting on the medial part and progressing towards the tail of the pancreas and the spleen. When approaching the spleen and the tail of the pancreas, attention is paid to the perfect identification of the splenic vessels, mostly the splenic vein, the idea being to preserve the left gastro-epiploic pedicle as it will help in the vascularization of the spleen together with the short gastric vessels, which have also been preserved. That is a condition to preserve the spleen while having divided the splenic vein and artery at the medial side. The splenic side of the artery and the vein is progressively identified. The origin of the left gastro-epiploic artery is also identified and will be preserved, if possible, during the distal division of the splenic vessels. This division will be performed using an endoscopic stapler, vascular cartridge, because of the difficulty in getting a good exposure of the distal part of these vessels just next to the spleen. The veins are isolated before stapling and division, and the left part of the pancreas is removed. A careful hemostasis is done. The vascularization of the spleen is controlled; in this patient we can see different areas with different vascularization. The upper pole of the spleen is well vascularized, probably due to the short gastric vessels, while the upper part is more congestive, but this is quite a usual aspect after this technique and in this patient, it doesn’t lead to any postoperative problems. Of course, there is a rule for pancreatic distal resections; we will leave drainage in the area of the pancreatic stump. Analyses will be checked regularly during the postoperative days before the removal of this drainage. The patient is allowed to drink the day after surgery. Drainage, as mentioned, will be kept until the 4th or 5th day after surgery and if amylasemia is normal within the liquid, then usually the patient is discharged at day 5 or 6 after surgery. In this patient, the pathology excluded the IPMN, but concluded to a multi-cystic lesion of the left pancreas with multiple dilatations of the exocrine duct of the pancreas, and in some of these dilatations, the pathologist found some areas of local and focal dysplasia. In this patient, the postoperative outcome was completely normal and the patient was discharged on day 6 after surgery.