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General and digestive surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
Robotic central pancreatectomy for a well-differentiated neuroendocrine tumor
In this video, we show a robotic central pancreatectomy for a well-differentiated neuroendocrine tumor. This is the case of a 50-year-old patient admitted to the emergency department for acute pancreatitis. CT-scan and MRI demonstrate the presence of a hypervascularized lesion of approximately 15mm in diameter, at the pancreatic isthmus. Scintigraphy does not evidence any intense uptake.
The colon and the omentum are detached and the stomach is suspended laparoscopically. The robot is docked using a lateral approach. A retropancreatic passage is achieved on the mesenteric-portal axis. An intraoperative ultrasonography is performed to visualize the tumor and delimitate the resection margins. After the dissection, the anastomosis is performed between the distal part of the pancreatic remnant and the posterior gastric wall.
A postoperative pancreatic fistula grade B was reported. It was successfully managed. The presence of a well-differentiated neuroendocrine tumor was confirmed. The patient was discharged on postoperative day 22.
P Pessaux, E Felli, T Wakabayashi, Z Cherkaoui, D Mutter, J Marescaux
Surgical intervention
1 month ago
1159 views
2 likes
3 comments
07:01
Robotic central pancreatectomy for a well-differentiated neuroendocrine tumor
In this video, we show a robotic central pancreatectomy for a well-differentiated neuroendocrine tumor. This is the case of a 50-year-old patient admitted to the emergency department for acute pancreatitis. CT-scan and MRI demonstrate the presence of a hypervascularized lesion of approximately 15mm in diameter, at the pancreatic isthmus. Scintigraphy does not evidence any intense uptake.
The colon and the omentum are detached and the stomach is suspended laparoscopically. The robot is docked using a lateral approach. A retropancreatic passage is achieved on the mesenteric-portal axis. An intraoperative ultrasonography is performed to visualize the tumor and delimitate the resection margins. After the dissection, the anastomosis is performed between the distal part of the pancreatic remnant and the posterior gastric wall.
A postoperative pancreatic fistula grade B was reported. It was successfully managed. The presence of a well-differentiated neuroendocrine tumor was confirmed. The patient was discharged on postoperative day 22.
Laparoscopic Frey's procedure with management of intraoperative complication
This is the case of a 61-year-old lady presenting with recurrent abdominal intractable pain she has been suffering from for the last 7 years. Multi-slice CT (MSCT) revealed pancreatic calcifications from 1 to 5-8mm and dilatation of the main pancreatic duct in the body of the pancreas up to 4mm. The patient underwent laparoscopic local resection of the pancreatic head combined with a longitudinal Roux-en-Y pancreaticojejunostomy, a technique known as Frey's procedure. It is recognized as an effective therapeutic option for the surgical treatment of patients with persistent pain caused by chronic pancreatitis.
After fashioning the posterior wall of the pancreaticojejunal anastomosis, we faced an intraoperative complication such as a volvulus of the Roux limb causing serious ischemia of the limb. We were forced to remove all previous sutures in order to untwist the Roux limb. The pancreaticojejunostomy was started anew afterwards.
The purpose of this video is to demonstrate that Frey's procedure can be performed in a minimally invasive fashion, which provides all the well-known advantages of this approach. We demonstrate that even a serious intraoperative complication such as a volvulus of the Roux limb can be managed without conversion. Our center has an experience of over 30 laparoscopic Frey's procedures. However, this is the first case where we encountered this complication and we believe this is an experience worth sharing.
Yet, we would like to underline that this approach should be used by highly skilled minimally invasive surgeons with an experience in intracorporeal suturing, which is the most challenging stage in Frey's procedure.
P Agami, A Andrianov, V Shchadrova, M Baychorov, R Izrailov
Surgical intervention
1 month ago
2283 views
7 likes
4 comments
12:28
Laparoscopic Frey's procedure with management of intraoperative complication
This is the case of a 61-year-old lady presenting with recurrent abdominal intractable pain she has been suffering from for the last 7 years. Multi-slice CT (MSCT) revealed pancreatic calcifications from 1 to 5-8mm and dilatation of the main pancreatic duct in the body of the pancreas up to 4mm. The patient underwent laparoscopic local resection of the pancreatic head combined with a longitudinal Roux-en-Y pancreaticojejunostomy, a technique known as Frey's procedure. It is recognized as an effective therapeutic option for the surgical treatment of patients with persistent pain caused by chronic pancreatitis.
After fashioning the posterior wall of the pancreaticojejunal anastomosis, we faced an intraoperative complication such as a volvulus of the Roux limb causing serious ischemia of the limb. We were forced to remove all previous sutures in order to untwist the Roux limb. The pancreaticojejunostomy was started anew afterwards.
The purpose of this video is to demonstrate that Frey's procedure can be performed in a minimally invasive fashion, which provides all the well-known advantages of this approach. We demonstrate that even a serious intraoperative complication such as a volvulus of the Roux limb can be managed without conversion. Our center has an experience of over 30 laparoscopic Frey's procedures. However, this is the first case where we encountered this complication and we believe this is an experience worth sharing.
Yet, we would like to underline that this approach should be used by highly skilled minimally invasive surgeons with an experience in intracorporeal suturing, which is the most challenging stage in Frey's procedure.
Laparoscopic distal pancreatectomy for intraductal papillary mucinous neoplasm (IPMN)
This is the case of a 76-year-old female patient who was referred to our hospital because of intraductal papillary mucinous neoplasm (IPMN). The patient has a medical history of renal insufficiency, sleep apnea syndrome, type 2 diabetes mellitus (T2DM), and hypertension. She has also a history of previous total hysterectomy.
MRI findings showed that the patient’s IPMN affected secondary pancreatic ducts entirely.
The main pancreatic duct is dilated, especially in the distal part at 6mm, but there are no remarkable findings of cystic wall thickening or intracystic nodules. A laparoscopic distal pancreatectomy was planned.
The postoperative course was uneventful and the patient was discharged on postoperative day 8.
Pathological findings showed that the intraductal papillary mucinous neoplasm was without any malignant component.
P Pessaux, E Felli, T Wakabayashi, D Mutter, J Marescaux
Surgical intervention
1 month ago
894 views
4 likes
0 comments
13:26
Laparoscopic distal pancreatectomy for intraductal papillary mucinous neoplasm (IPMN)
This is the case of a 76-year-old female patient who was referred to our hospital because of intraductal papillary mucinous neoplasm (IPMN). The patient has a medical history of renal insufficiency, sleep apnea syndrome, type 2 diabetes mellitus (T2DM), and hypertension. She has also a history of previous total hysterectomy.
MRI findings showed that the patient’s IPMN affected secondary pancreatic ducts entirely.
The main pancreatic duct is dilated, especially in the distal part at 6mm, but there are no remarkable findings of cystic wall thickening or intracystic nodules. A laparoscopic distal pancreatectomy was planned.
The postoperative course was uneventful and the patient was discharged on postoperative day 8.
Pathological findings showed that the intraductal papillary mucinous neoplasm was without any malignant component.
Robotic distal pancreatectomy with splenectomy
This is the case of a 73-year-old asymptomatic female patient who presented with an incidental pancreatic lesion on CT-scan. Her previous medical history was relevant for systemic lupus erythematosus. On the CT-scan, a single hypervascular lesion in the arterial phase was identified in the distal pancreas. The lesion size was 3.1 by 3.3 by 4.3cm. Neither suspicious nodes nor distant metastases were found. The patient was considered to be ASA2 and ECOG0.
The patient was placed in a reverse Trendelenburg position. A 12mm port was placed in the umbilicus for the camera, and three 8mm ports were inserted to accommodate the robotic arms, and another 12mm auxiliary port was used.
The greater curvature of the stomach was released from the transverse colon to expose the supramesocolic area. The neck of the pancreas was dissected close to the splenic-mesenteric confluence. The inferior mesenteric vein opening to the splenic vein was identified, clipped and cut. The splenic artery was dissected, clipped and cut close to the celiac trunk. A stapler was placed in the neck of the pancreas and it was safely stapled. The splenic vein was dissected close to the confluence, and then clipped and cut. The distal pancreas and splenic ligaments were cut and . detached. The specimen was removed using a Pfannenstiel’s incision.
The duration of the procedure was 255 minutes. The estimated blood loss was 100mL. The patient was discharged on postoperative day 5 and no complication was observed over a period of 90 days. Pathology confirmed the presence of a neuroendocrine tumor (grade 2) as a 4cm single lesion and negative margins. One positive node was detected among 10 nodes harvested.
R Araujo, MA Sanctis, F Felippe, D Burgardt, D Wohnrath
Surgical intervention
1 month ago
357 views
2 likes
0 comments
08:04
Robotic distal pancreatectomy with splenectomy
This is the case of a 73-year-old asymptomatic female patient who presented with an incidental pancreatic lesion on CT-scan. Her previous medical history was relevant for systemic lupus erythematosus. On the CT-scan, a single hypervascular lesion in the arterial phase was identified in the distal pancreas. The lesion size was 3.1 by 3.3 by 4.3cm. Neither suspicious nodes nor distant metastases were found. The patient was considered to be ASA2 and ECOG0.
The patient was placed in a reverse Trendelenburg position. A 12mm port was placed in the umbilicus for the camera, and three 8mm ports were inserted to accommodate the robotic arms, and another 12mm auxiliary port was used.
The greater curvature of the stomach was released from the transverse colon to expose the supramesocolic area. The neck of the pancreas was dissected close to the splenic-mesenteric confluence. The inferior mesenteric vein opening to the splenic vein was identified, clipped and cut. The splenic artery was dissected, clipped and cut close to the celiac trunk. A stapler was placed in the neck of the pancreas and it was safely stapled. The splenic vein was dissected close to the confluence, and then clipped and cut. The distal pancreas and splenic ligaments were cut and . detached. The specimen was removed using a Pfannenstiel’s incision.
The duration of the procedure was 255 minutes. The estimated blood loss was 100mL. The patient was discharged on postoperative day 5 and no complication was observed over a period of 90 days. Pathology confirmed the presence of a neuroendocrine tumor (grade 2) as a 4cm single lesion and negative margins. One positive node was detected among 10 nodes harvested.
Laparoscopic en bloc splenopancreatectomy with left adrenalectomy and para-aortic lymphadenectomy
The objective of this video is to present a surgical approach to a left adrenal mass caused by the invasion of a pancreatic lesion. A pulmonary lesion was also found. However, a preoperative biopsy of that lesion was impossible to perform. In order to distinguish the primary origin of this lung lesion, a laparoscopic ‘en bloc’ splenopancreatectomy combined with a left adrenalectomy and a para-aortic lymphadenectomy were planned.
Retrograde distal pancreatectomy with splenectomy is the standard procedure for cancers of the body and tail of the pancreas. In the literature, fewer studies describe the feasibility and the oncological safety of the laparoscopic approach.
This video aims to show the different operative steps of the procedure beginning with laparoscopic adrenalectomy followed by distal pancreatectomy and para-aortic lympadenectomy.
R Romito, L Portigliotti, G Bondonno, M Zacchero, A Volpe
Surgical intervention
1 month ago
281 views
6 likes
1 comment
13:28
Laparoscopic en bloc splenopancreatectomy with left adrenalectomy and para-aortic lymphadenectomy
The objective of this video is to present a surgical approach to a left adrenal mass caused by the invasion of a pancreatic lesion. A pulmonary lesion was also found. However, a preoperative biopsy of that lesion was impossible to perform. In order to distinguish the primary origin of this lung lesion, a laparoscopic ‘en bloc’ splenopancreatectomy combined with a left adrenalectomy and a para-aortic lymphadenectomy were planned.
Retrograde distal pancreatectomy with splenectomy is the standard procedure for cancers of the body and tail of the pancreas. In the literature, fewer studies describe the feasibility and the oncological safety of the laparoscopic approach.
This video aims to show the different operative steps of the procedure beginning with laparoscopic adrenalectomy followed by distal pancreatectomy and para-aortic lympadenectomy.
Pancreatic duplication associated with a gastric duplication cyst: laparoscopic approach
This video shows the case of a 48-year-old male patient with a history of epigastric pain for 20 days, with the presence of nausea and vomiting but no self-reported fever. The patient was presented at the ER for examination. Computerized tomography (CT) scanning revealed a very rare case of pancreatic duplication associated with a gastric duplication cyst. He was referred to our service and then treated by laparoscopic route with partial gastrectomy and pancreatic resection (pancreas horn). On the 2nd postoperative day, the patient was discharged and allowed for free oral feeding. This is the second study in the literature reporting a case of laparoscopic resection of a gastric duplication cyst together with pancreatic resection. Of note, this is the first study in which the accessory pancreas communicates with the pancreatic head.
F Freire Lisboa Junior, R de Lima França, A de Araujo Lima Liguori, AC de Medeiros Junior, M HSMP Tavares, F Medeiros de Azevedo, D Myller Barros Lima
Surgical intervention
2 months ago
1035 views
4 likes
0 comments
14:36
Pancreatic duplication associated with a gastric duplication cyst: laparoscopic approach
This video shows the case of a 48-year-old male patient with a history of epigastric pain for 20 days, with the presence of nausea and vomiting but no self-reported fever. The patient was presented at the ER for examination. Computerized tomography (CT) scanning revealed a very rare case of pancreatic duplication associated with a gastric duplication cyst. He was referred to our service and then treated by laparoscopic route with partial gastrectomy and pancreatic resection (pancreas horn). On the 2nd postoperative day, the patient was discharged and allowed for free oral feeding. This is the second study in the literature reporting a case of laparoscopic resection of a gastric duplication cyst together with pancreatic resection. Of note, this is the first study in which the accessory pancreas communicates with the pancreatic head.
Laparoscopic distal splenopancreatectomy for pancreatic cystadenoma: clockwise technique assisted with T’Lift device
Serous cystic neoplasm is a cystic neoplasm of the pancreas, which is increasingly detected at an asymptomatic stage. Serous cystadenomas are benign cystic tumors which occur more often in women than in men, and particularly in the seventh decade of life. Despite this, in the literature, three patients were reported to have malignant serous cystadenomas, with sizes greater than 7cm. The serous cystic neoplasm was confirmed by an imaging characteristic appearance, with multiple small or different-sized cysts, but when the diagnosis is doubtful, which often leads to surgery.
The clinical case is the one of a 79-year-old woman with a cystadenoma of the pancreas. She had a history of partial cystectomy for bladder neoplasia and recently (in 2017), she was submitted to laparoscopic focal cryotherapy for the treatment of a left unilateral renal tumor. At that time, she underwent a CT-can, which found a cystic neoplasm of the tail of the pancreas. A heterogeneous 5cm lesion appeared in the left hypochondrium, near the lower pole of the spleen, with no evidence of adenopathies highly suggestive of a serous cystadenoma of the pancreas.
In October 2018, in a follow-up CT-scan, there was an increase in size of the lesion (6.6cm) and a surgical resection was planned. A distal splenopancreatectomy using a clockwise technique was performed using the Signia™ stapling system with no complications. Histological examination confirmed a serous cystadenoma of the pancreas.
M Rui Martins, J Correia, D Jordão, S Martins, H Ferrão
Surgical intervention
2 months ago
844 views
4 likes
0 comments
20:59
Laparoscopic distal splenopancreatectomy for pancreatic cystadenoma: clockwise technique assisted with T’Lift device
Serous cystic neoplasm is a cystic neoplasm of the pancreas, which is increasingly detected at an asymptomatic stage. Serous cystadenomas are benign cystic tumors which occur more often in women than in men, and particularly in the seventh decade of life. Despite this, in the literature, three patients were reported to have malignant serous cystadenomas, with sizes greater than 7cm. The serous cystic neoplasm was confirmed by an imaging characteristic appearance, with multiple small or different-sized cysts, but when the diagnosis is doubtful, which often leads to surgery.
The clinical case is the one of a 79-year-old woman with a cystadenoma of the pancreas. She had a history of partial cystectomy for bladder neoplasia and recently (in 2017), she was submitted to laparoscopic focal cryotherapy for the treatment of a left unilateral renal tumor. At that time, she underwent a CT-can, which found a cystic neoplasm of the tail of the pancreas. A heterogeneous 5cm lesion appeared in the left hypochondrium, near the lower pole of the spleen, with no evidence of adenopathies highly suggestive of a serous cystadenoma of the pancreas.
In October 2018, in a follow-up CT-scan, there was an increase in size of the lesion (6.6cm) and a surgical resection was planned. A distal splenopancreatectomy using a clockwise technique was performed using the Signia™ stapling system with no complications. Histological examination confirmed a serous cystadenoma of the pancreas.
Laparoscopic distal pancreatectomy with splenectomy for a recurrent GIST
GISTs are tumors of the gastrointestinal stroma which, although rare, are the most common mesenchymal neoplasms of the digestive tract. They are most common in the stomach and small intestine, in patients aged between 50 and 70 years. The definitive diagnosis is established with immunohistochemistry (CD117), and the risk of postoperative recurrence should be estimated. Studies relate small intestine’s lesions with greater aggressiveness; however, more recent studies emphasize mitotic index and lesion size.
The clinical case is that of a 53-year-old woman with a stage TNM IIIb, AFIP 6b gastric GIST. In 2013, she underwent a sleeve gastrectomy followed by the daily administration of Imatinib (400mg). After 3 years of adjuvant therapy, she stopped treatment. In May 2017, in a follow-up CT-scan, a solid, heterogeneous 6.7cm lesion appeared in the left hypochondrium, separated from the metal suture, invading the lower pole of the spleen, with no evidence of adenopathies or free liquid.
Surgical resection was planned. A splenectomy with distal pancreatectomy, documented in the video, was performed with no complications. The histological examination confirmed a 5.8cm tumor implant, located in the splenic cord, compatible with GIST recurrence (>50 mitoses/50 fields, free margins, prognostic group 6b).
JP Pinto, T Moreno, D Poletto, A Toscano, M Lozano
Surgical intervention
7 months ago
2029 views
4 likes
0 comments
14:02
Laparoscopic distal pancreatectomy with splenectomy for a recurrent GIST
GISTs are tumors of the gastrointestinal stroma which, although rare, are the most common mesenchymal neoplasms of the digestive tract. They are most common in the stomach and small intestine, in patients aged between 50 and 70 years. The definitive diagnosis is established with immunohistochemistry (CD117), and the risk of postoperative recurrence should be estimated. Studies relate small intestine’s lesions with greater aggressiveness; however, more recent studies emphasize mitotic index and lesion size.
The clinical case is that of a 53-year-old woman with a stage TNM IIIb, AFIP 6b gastric GIST. In 2013, she underwent a sleeve gastrectomy followed by the daily administration of Imatinib (400mg). After 3 years of adjuvant therapy, she stopped treatment. In May 2017, in a follow-up CT-scan, a solid, heterogeneous 6.7cm lesion appeared in the left hypochondrium, separated from the metal suture, invading the lower pole of the spleen, with no evidence of adenopathies or free liquid.
Surgical resection was planned. A splenectomy with distal pancreatectomy, documented in the video, was performed with no complications. The histological examination confirmed a 5.8cm tumor implant, located in the splenic cord, compatible with GIST recurrence (>50 mitoses/50 fields, free margins, prognostic group 6b).
Laparoscopic pancreatectomy with preservation of splenic vessels: a live broadcast from IRCAD America Latina, Barretos, Brazil
In this instructional video, Dr. Bernard Dallemagne demonstrated the main principles and key steps of laparoscopic pancreatectomy with the preservation of splenic vessels (Kimura technique) in a 58-year-old woman with a complex cyst of the body and tail of the pancreas. He briefly described the technical aspects and maneuvers for a better exposure and dissection of the inferior and superior border of the pancreas. He highlighted the tips and tricks for opening the gastrocolic ligament, the identification and dissection of vessels, the mobilization of the pancreas, dissection line reinforcement, and specimen removal.
B Dallemagne, S Perretta, R Araujo
Surgical intervention
1 year ago
5071 views
596 likes
1 comment
38:09
Laparoscopic pancreatectomy with preservation of splenic vessels: a live broadcast from IRCAD America Latina, Barretos, Brazil
In this instructional video, Dr. Bernard Dallemagne demonstrated the main principles and key steps of laparoscopic pancreatectomy with the preservation of splenic vessels (Kimura technique) in a 58-year-old woman with a complex cyst of the body and tail of the pancreas. He briefly described the technical aspects and maneuvers for a better exposure and dissection of the inferior and superior border of the pancreas. He highlighted the tips and tricks for opening the gastrocolic ligament, the identification and dissection of vessels, the mobilization of the pancreas, dissection line reinforcement, and specimen removal.
Laparoscopic distal pancreatectomy with spleen resection
We reported a laparoscopic distal pancreatectomy with spleen resection for a mucinous cystic lesion. Four ports were positioned. The greater omentum was retracted to the superior part of the abdomen in order to detach the colon from the omentum and approach the lesser sac. The stomach was dissected. A tape was placed around the stomach through the abdominal wall, making it possible to retract the stomach at the level of the pyloric junction towards the upper part of the abdomen. A second tape was placed at the antral part in order to achieve a retraction towards the left hypochondrium at the superior part of the abdomen. The mesentericoportal axis was identified and dissected at the inferior border of the pancreas. The right gastroepiploic vein was one of the landmarks. The superior border of the pancreas was dissected in order to identify the splenic artery and a tape was positioned around it. The dissection was performed progressively at the anterior aspect of the mesentericoportal axis through an avascular channel. A tape was subsequently positioned around the pancreatic isthmus. The pancreas was divided with a stapler. The stapling was performed very progressively to avoid crushing the pancreas. The splenic vein was dissected in order to preserve the left gastric vein and a tape was positioned around it. The splenic artery was first divided between two clips on the remaining surface. The splenic vein was also divided. Dissection was pursued from the right to the left, making it possible to mobilize the pancreas. The inferior mesenteric vein was dissected and divided. Dissection of the posterior mesogastrium was initiated, making it possible to mobilize the splenopancreatic block. The dissection was performed anteriorly to the plane of Gerota’s fascia, anteriorly to the kidney. Since the posterior dissection was almost complete, our attention was turned to the superior part to complete the dissection of lesser sac adhesions at the superior border of the pancreas. It was necessary to divide the greater omentum by gradually dividing the short gastric vessels. Due to venous derivations linked to segmental portal hypertension, this dissection was performed through the application of the Endo GIA™ linear stapler. Since the entire specimen had been divided and freed, it was placed in a bag to be extracted through a suprapubic Pfannenstiel’s incision.
P Pessaux, X Untereiner, Z Cherkaoui, V Louis, D Mutter, J Marescaux
Surgical intervention
1 year ago
4823 views
604 likes
0 comments
45:34
Laparoscopic distal pancreatectomy with spleen resection
We reported a laparoscopic distal pancreatectomy with spleen resection for a mucinous cystic lesion. Four ports were positioned. The greater omentum was retracted to the superior part of the abdomen in order to detach the colon from the omentum and approach the lesser sac. The stomach was dissected. A tape was placed around the stomach through the abdominal wall, making it possible to retract the stomach at the level of the pyloric junction towards the upper part of the abdomen. A second tape was placed at the antral part in order to achieve a retraction towards the left hypochondrium at the superior part of the abdomen. The mesentericoportal axis was identified and dissected at the inferior border of the pancreas. The right gastroepiploic vein was one of the landmarks. The superior border of the pancreas was dissected in order to identify the splenic artery and a tape was positioned around it. The dissection was performed progressively at the anterior aspect of the mesentericoportal axis through an avascular channel. A tape was subsequently positioned around the pancreatic isthmus. The pancreas was divided with a stapler. The stapling was performed very progressively to avoid crushing the pancreas. The splenic vein was dissected in order to preserve the left gastric vein and a tape was positioned around it. The splenic artery was first divided between two clips on the remaining surface. The splenic vein was also divided. Dissection was pursued from the right to the left, making it possible to mobilize the pancreas. The inferior mesenteric vein was dissected and divided. Dissection of the posterior mesogastrium was initiated, making it possible to mobilize the splenopancreatic block. The dissection was performed anteriorly to the plane of Gerota’s fascia, anteriorly to the kidney. Since the posterior dissection was almost complete, our attention was turned to the superior part to complete the dissection of lesser sac adhesions at the superior border of the pancreas. It was necessary to divide the greater omentum by gradually dividing the short gastric vessels. Due to venous derivations linked to segmental portal hypertension, this dissection was performed through the application of the Endo GIA™ linear stapler. Since the entire specimen had been divided and freed, it was placed in a bag to be extracted through a suprapubic Pfannenstiel’s incision.
Basic principles and technical tips for laparoscopic pancreatectomy
With the improved laparoscopic instruments and energy devices, laparoscopy has become increasingly popular among surgeons. In this video, Professor Asbun outlines principles and tips for laparoscopic pancreatectomy. Beginners and young surgeons have to fully commit themselves in the training as there is no shortcut in the learning of laparoscopic surgery. Patient position plays a key role in laparoscopic solid organ surgery. The surgeons are using gravity to make the surgery easier. Placement of ports for pancreaticoduodenectomy in Kocher’s maneuver is as essential as the exposure of the operative field. Camera, laparoscope and instrumentation also play a key role. As energy devices are diverse and since the learning curve is different for each surgeon, the importance of technical tips cannot be neglected. In advanced techniques, HPB training is essential and suturing is the basic and most important part. Exposure, division of the duodenum and hepatoduodenal ligament, SMV-PV trunk exposure, Kocher’s maneuver, pancreatic neck division, identification of the pancreatic duct, uncinate process dissection, SMA dissection, lymph node dissection, and specimen removal represent the steps of the procedure. Laparoscopic surgery should be a standard for distal pancreatectomy. The superiority of laparoscopy over open surgery still needs to be proven as laparoscopy requires a high level of skills.
HJ Asbun
Lecture
1 year ago
4280 views
161 likes
0 comments
33:33
Basic principles and technical tips for laparoscopic pancreatectomy
With the improved laparoscopic instruments and energy devices, laparoscopy has become increasingly popular among surgeons. In this video, Professor Asbun outlines principles and tips for laparoscopic pancreatectomy. Beginners and young surgeons have to fully commit themselves in the training as there is no shortcut in the learning of laparoscopic surgery. Patient position plays a key role in laparoscopic solid organ surgery. The surgeons are using gravity to make the surgery easier. Placement of ports for pancreaticoduodenectomy in Kocher’s maneuver is as essential as the exposure of the operative field. Camera, laparoscope and instrumentation also play a key role. As energy devices are diverse and since the learning curve is different for each surgeon, the importance of technical tips cannot be neglected. In advanced techniques, HPB training is essential and suturing is the basic and most important part. Exposure, division of the duodenum and hepatoduodenal ligament, SMV-PV trunk exposure, Kocher’s maneuver, pancreatic neck division, identification of the pancreatic duct, uncinate process dissection, SMA dissection, lymph node dissection, and specimen removal represent the steps of the procedure. Laparoscopic surgery should be a standard for distal pancreatectomy. The superiority of laparoscopy over open surgery still needs to be proven as laparoscopy requires a high level of skills.
Laparoscopic distal pancreatectomy with splenectomy
In this video, a laparoscopic distal pancreatectomy with a splenectomy is demonstrated. The colon is mobilized from the omentum and the splenic flexure is lowered completely. The dissection is completed towards the right side in order to access the pancreatic isthmus. The dissection is initiated at the level of the inferior pancreatic port in order to identify the mesentericoportal axis. The retropancreatic dissection is performed. The splenic vein and the splenic artery are dissected and taped. A tape is placed around the pancreas in order to facilitate the dissection thanks to the traction exerted. The pancreas is divided by means of a stapler, tan cartridge. The splenic vessels were divided through Hem-o-lok™ Polymer Locking Ligation Systems. The dissection is performed from the right to the left side of the retropancreatic region. The greater omentum is dissected in close contact with the greater curvature of the stomach. The short gastric vessels are progressively divided. The division of the posterior mesogastrium allows to completely free the specimen, which is then placed in a bag. The specimen is removed through a suprapubic Pfannenstiel’s incision.
P Pessaux, R Memeo, V De Blasi, D Mutter, J Marescaux
Surgical intervention
1 year ago
2231 views
159 likes
0 comments
21:51
Laparoscopic distal pancreatectomy with splenectomy
In this video, a laparoscopic distal pancreatectomy with a splenectomy is demonstrated. The colon is mobilized from the omentum and the splenic flexure is lowered completely. The dissection is completed towards the right side in order to access the pancreatic isthmus. The dissection is initiated at the level of the inferior pancreatic port in order to identify the mesentericoportal axis. The retropancreatic dissection is performed. The splenic vein and the splenic artery are dissected and taped. A tape is placed around the pancreas in order to facilitate the dissection thanks to the traction exerted. The pancreas is divided by means of a stapler, tan cartridge. The splenic vessels were divided through Hem-o-lok™ Polymer Locking Ligation Systems. The dissection is performed from the right to the left side of the retropancreatic region. The greater omentum is dissected in close contact with the greater curvature of the stomach. The short gastric vessels are progressively divided. The division of the posterior mesogastrium allows to completely free the specimen, which is then placed in a bag. The specimen is removed through a suprapubic Pfannenstiel’s incision.
Spleen and splenic vessel preserving distal pancreatectomy for bifocal PNET in a young patient with MEN1
In this key lecture, Dr. Conrad outlines key steps related to spleen and splenic vessel preserving distal pancreatectomy, laparoscopic insulinoma enucleation of the posterior pancreatic neck, and laparoscopic partial splenectomy. He stresses the technical aspects of intraoperative ultrasonography, celiac trunk dissection, and gives some recommendations with regards to leak reduction, vascular dissection, and energy device use. He provides tips and tricks for insulinoma dissection and emphasizes key concepts and technical points for main pancreatic duct preservation, hilum dissection, and spleen transection.
C Conrad
Lecture
1 year ago
920 views
67 likes
0 comments
15:24
Spleen and splenic vessel preserving distal pancreatectomy for bifocal PNET in a young patient with MEN1
In this key lecture, Dr. Conrad outlines key steps related to spleen and splenic vessel preserving distal pancreatectomy, laparoscopic insulinoma enucleation of the posterior pancreatic neck, and laparoscopic partial splenectomy. He stresses the technical aspects of intraoperative ultrasonography, celiac trunk dissection, and gives some recommendations with regards to leak reduction, vascular dissection, and energy device use. He provides tips and tricks for insulinoma dissection and emphasizes key concepts and technical points for main pancreatic duct preservation, hilum dissection, and spleen transection.
Robotic pancreaticoduodenectomy for vaterian ampulloma
We report the case of a robot-assisted pancreaticoduodenectomy for vaterian ampulloma. The patient is positioned in the French position with the assistant between the legs and the robot at the head. Five trocars are used: the camera is introduced through the umbilical trocar. The operation begins with the exploration of the peritoneum and of the liver. The gastric antrum is divided. Each structure of the hepatic pedicle is skeletonized. The superior border of the pancreas is dissected, hence allowing to approach the mesentericoportal axis.
The surgeon proceeds to the inferior border of the pancreas in order to find the mesentericoportal axis and to achieve a retropancreatic passage, which is where the pancreas will be divided. The pancreas is divided using the Sonicision™ cordless ultrasonic dissection device. The first jejunal loop is divided with a stapler. The specimen is totally mobilized ‘en bloc’, and freed from the portal vascular axis with a dissection of the right border of the coeliac trunk. At the end of the dissection, the different arterial and venous structures are skeletonized with a lymph node resection. The reconstruction is performed with a pancreaticogastrostomy, hepaticojejunostomy, and gastrojejunostomy.
P Pessaux, R Memeo, V De Blasi, D Mutter, J Marescaux
Surgical intervention
1 year ago
2287 views
235 likes
0 comments
28:02
Robotic pancreaticoduodenectomy for vaterian ampulloma
We report the case of a robot-assisted pancreaticoduodenectomy for vaterian ampulloma. The patient is positioned in the French position with the assistant between the legs and the robot at the head. Five trocars are used: the camera is introduced through the umbilical trocar. The operation begins with the exploration of the peritoneum and of the liver. The gastric antrum is divided. Each structure of the hepatic pedicle is skeletonized. The superior border of the pancreas is dissected, hence allowing to approach the mesentericoportal axis.
The surgeon proceeds to the inferior border of the pancreas in order to find the mesentericoportal axis and to achieve a retropancreatic passage, which is where the pancreas will be divided. The pancreas is divided using the Sonicision™ cordless ultrasonic dissection device. The first jejunal loop is divided with a stapler. The specimen is totally mobilized ‘en bloc’, and freed from the portal vascular axis with a dissection of the right border of the coeliac trunk. At the end of the dissection, the different arterial and venous structures are skeletonized with a lymph node resection. The reconstruction is performed with a pancreaticogastrostomy, hepaticojejunostomy, and gastrojejunostomy.
Completely intracorporeal handsewn laparoscopic anastomoses during Whipple procedure
Background: Since 1935, the Whipple procedure was described, using conventional open surgery. With the advent of minimally invasive surgery (MIS), it was reported to be feasible also using the latest technology. In this video, the authors demonstrate a full laparoscopic Whipple procedure, performing the three anastomoses using an intracorporeal handsewn method.

Video: A 70-year-old man presenting with an adenocarcinoma of the ampulla of Vater, infiltrating the pancreatic parenchyma, underwent a laparoscop ic Whipple procedure. Preoperative work-up showed a T3N1M0 tumor.

Results: Total operative time was 8 hours 20minutes; time for the dissection was 6 hours 20 minutes; time for specimen extraction was 20 minutes, and time for the three laparoscopic intracorporeal handsewn anastomoses was 1 hour 40 minutes. Operative bleeding was 350cc. The patient was discharged on postoperative day 9. Pathological findings confirmed a moderately differentiated adenocarcinoma of the ampulla of Vater, with perinervous infiltration and lymphovascular emboli, free margins, 2 metastatic lymph nodes on 23 isolated; 7 edition UICC stage: pT4N1.

Conclusions: The laparoscopic Whipple procedure remains an advanced procedure to be performed laparoscopically and/or using open surgery. All the advantages of MIS such as reduced abdominal trauma, less postoperative pain, shorter hospital stay, improved patient’s comfort, and enhanced cosmesis are offered using laparoscopy.
G Dapri, NA Bascombe, L Gerard, C Samaniego Ballar, C Jiménez Viñas
Surgical intervention
1 year ago
2613 views
220 likes
2 comments
10:22
Completely intracorporeal handsewn laparoscopic anastomoses during Whipple procedure
Background: Since 1935, the Whipple procedure was described, using conventional open surgery. With the advent of minimally invasive surgery (MIS), it was reported to be feasible also using the latest technology. In this video, the authors demonstrate a full laparoscopic Whipple procedure, performing the three anastomoses using an intracorporeal handsewn method.

Video: A 70-year-old man presenting with an adenocarcinoma of the ampulla of Vater, infiltrating the pancreatic parenchyma, underwent a laparoscop ic Whipple procedure. Preoperative work-up showed a T3N1M0 tumor.

Results: Total operative time was 8 hours 20minutes; time for the dissection was 6 hours 20 minutes; time for specimen extraction was 20 minutes, and time for the three laparoscopic intracorporeal handsewn anastomoses was 1 hour 40 minutes. Operative bleeding was 350cc. The patient was discharged on postoperative day 9. Pathological findings confirmed a moderately differentiated adenocarcinoma of the ampulla of Vater, with perinervous infiltration and lymphovascular emboli, free margins, 2 metastatic lymph nodes on 23 isolated; 7 edition UICC stage: pT4N1.

Conclusions: The laparoscopic Whipple procedure remains an advanced procedure to be performed laparoscopically and/or using open surgery. All the advantages of MIS such as reduced abdominal trauma, less postoperative pain, shorter hospital stay, improved patient’s comfort, and enhanced cosmesis are offered using laparoscopy.
Laparoscopic distal pancreatectomy and splenectomy for a mucinous cystic neoplasm of the pancreas
This video shows a laparoscopic distal pancreatectomy and splenectomy.
This is the case of a woman with a cystic lesion in the body of the pancreas, diagnosed in the study of an abdominal pain.
She was submitted to a CT-scan which showed a regular, well-defined 45mm cystic lesion in the pancreatic body, with voluminous hepatic hemangiomas. The findings of endoscopic ultrasound-guided biopsy were inconclusive, with a CEA of 653ng/dL.
The patient underwent a laparoscopic distal pancreatectomy and splenectomy.
There were no postoperative complications. The patient was discharged on postoperative day 3.
Histological findings demonstrated the presence of a mucinous cystic neoplasm.
L Ferreira, N Vilela, O Oliveira, J Miranda
Surgical intervention
2 years ago
2089 views
149 likes
0 comments
10:35
Laparoscopic distal pancreatectomy and splenectomy for a mucinous cystic neoplasm of the pancreas
This video shows a laparoscopic distal pancreatectomy and splenectomy.
This is the case of a woman with a cystic lesion in the body of the pancreas, diagnosed in the study of an abdominal pain.
She was submitted to a CT-scan which showed a regular, well-defined 45mm cystic lesion in the pancreatic body, with voluminous hepatic hemangiomas. The findings of endoscopic ultrasound-guided biopsy were inconclusive, with a CEA of 653ng/dL.
The patient underwent a laparoscopic distal pancreatectomy and splenectomy.
There were no postoperative complications. The patient was discharged on postoperative day 3.
Histological findings demonstrated the presence of a mucinous cystic neoplasm.
Laparoscopic distal pancreatectomy with spleen preservation
Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. Nowadays, more than 80% of distal pancreatectomies are performed laparoscopically. The basic advantages of this approach over the open approach are the following: reduced blood loss, fewer complications, and shorter hospital stay. Pancreatic neoplasms, chronic pancreatitis, and pancreatic cysts are the main indications for laparoscopic distal pancreatectomy. Distal pancreatosplenectomy and spleen-preserving pancreatectomy are contraindicated in metastatic diseases, peritoneal carcinosis, vascular invasion, and pancreatitis involving the entire pancreas. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation should preferably be achieved by preserving the splenic vessels (Kimura technique), but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and the left gastroepiploic artery (Warshaw’s technique).
AM Cury
Lecture
2 years ago
1901 views
73 likes
0 comments
11:42
Laparoscopic distal pancreatectomy with spleen preservation
Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. Nowadays, more than 80% of distal pancreatectomies are performed laparoscopically. The basic advantages of this approach over the open approach are the following: reduced blood loss, fewer complications, and shorter hospital stay. Pancreatic neoplasms, chronic pancreatitis, and pancreatic cysts are the main indications for laparoscopic distal pancreatectomy. Distal pancreatosplenectomy and spleen-preserving pancreatectomy are contraindicated in metastatic diseases, peritoneal carcinosis, vascular invasion, and pancreatitis involving the entire pancreas. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation should preferably be achieved by preserving the splenic vessels (Kimura technique), but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and the left gastroepiploic artery (Warshaw’s technique).
Total laparoscopic pancreatico-duodenectomy
Laparoscopic pancreatectomy has recently emerged as one of the most advanced applications of surgery and total laparoscopic pancreaticoduodenectomy (TLPD) has proven to be among one of the most advanced laparoscopic procedures. The evolution in laparoscopic technology and instrumentation within the past decade has let laparoscopic pancreaticoduodenectomy gain wider acceptance. Also known as the Whipple procedure, it was first performed laparoscopically in 1994. It consists of a biliary-enteric and of a gastro-enteric anastomosis. It is a two-step procedure: dissection is performed first, reconstruction follows. The laparoscopic approach requires comparatively longer operative times and necessitates advanced laparoscopic skills and hybrid approaches. Bleeding is a severe complication. People die of gastroduodenal and hepatic artery bleeding. The retroperitoneal part of the pancreas is involved in 51 to 93% of cases. Bleeding is a major complication during this procedure, which can be controlled by compressing, inserting another port, clamping, and stitching.
AM Cury
Lecture
2 years ago
2772 views
130 likes
0 comments
24:39
Total laparoscopic pancreatico-duodenectomy
Laparoscopic pancreatectomy has recently emerged as one of the most advanced applications of surgery and total laparoscopic pancreaticoduodenectomy (TLPD) has proven to be among one of the most advanced laparoscopic procedures. The evolution in laparoscopic technology and instrumentation within the past decade has let laparoscopic pancreaticoduodenectomy gain wider acceptance. Also known as the Whipple procedure, it was first performed laparoscopically in 1994. It consists of a biliary-enteric and of a gastro-enteric anastomosis. It is a two-step procedure: dissection is performed first, reconstruction follows. The laparoscopic approach requires comparatively longer operative times and necessitates advanced laparoscopic skills and hybrid approaches. Bleeding is a severe complication. People die of gastroduodenal and hepatic artery bleeding. The retroperitoneal part of the pancreas is involved in 51 to 93% of cases. Bleeding is a major complication during this procedure, which can be controlled by compressing, inserting another port, clamping, and stitching.
Total laparoscopic pancreaticoduodenectomy with pancreaticogastric anastomosis
The safe feasibility of total laparoscopic pancreaticoduodenectomy has been demonstrated by several authors. In order to achieve it, a 5-port approach is used. Kocher’s maneuver allows to access the inferior vena cava, the subrenal aorta, the posterior plate of the unciform process, and the superior mesenteric artery. Lymph node resection of the region may be performed completely, namely an interaorticocaval lymphadenectomy around the hepatoduodenal ligament and around the coeliac trunk and its branches. After portal vein dissection, the pancreas must be divided distally from the tumor, and its right part must be separated from the portal vein. The duodenal bulb and the first jejunal loop are divided using a linear stapler. After cholecystectomy, the hepatic duct is cut proximally to the cystic duct. Reconstruction will include three anastomoses, a telescoping posterior end-to-side pancreaticogastrostomy, an end-to-side duodenojejunostomy, and an end-to-side hepaticojejunostomy.
B Ghavami
Surgical intervention
2 years ago
1756 views
60 likes
0 comments
13:35
Total laparoscopic pancreaticoduodenectomy with pancreaticogastric anastomosis
The safe feasibility of total laparoscopic pancreaticoduodenectomy has been demonstrated by several authors. In order to achieve it, a 5-port approach is used. Kocher’s maneuver allows to access the inferior vena cava, the subrenal aorta, the posterior plate of the unciform process, and the superior mesenteric artery. Lymph node resection of the region may be performed completely, namely an interaorticocaval lymphadenectomy around the hepatoduodenal ligament and around the coeliac trunk and its branches. After portal vein dissection, the pancreas must be divided distally from the tumor, and its right part must be separated from the portal vein. The duodenal bulb and the first jejunal loop are divided using a linear stapler. After cholecystectomy, the hepatic duct is cut proximally to the cystic duct. Reconstruction will include three anastomoses, a telescoping posterior end-to-side pancreaticogastrostomy, an end-to-side duodenojejunostomy, and an end-to-side hepaticojejunostomy.
Laparoscopic distal pancreatectomy
Almost all lesions smaller than 7cm, which do not involve the coeliac or mesenteric vessels, should be considered for laparoscopic distal pancreatectomy. Several meta-analyses showed the clear benefits of laparoscopic distal pancreatectomy over open surgery regarding blood loss, hospital stay, morbidity, and wound infection. The comparison of open surgery vs. laparoscopic surgery in patients presenting with adenocarcinoma shows the benefits of laparoscopic surgery. It is much easier to learn this technique. In this lecture, the clockwise technique is briefly demonstrated. Gravity, ports position and instrumentation are essential. The key steps of the clockwise technique are as follows: mobilization of the splenic flexure and of the proximal descending colon, dissection from lateral to medial along the lower edge of the pancreas, determination of the point of division (stapled or hand-sewn), posterior dissection, mobilization of the spleen using gravity along the superior edge of the pancreas, and removal of the specimen.
HJ Asbun
Lecture
2 years ago
1988 views
58 likes
0 comments
13:55
Laparoscopic distal pancreatectomy
Almost all lesions smaller than 7cm, which do not involve the coeliac or mesenteric vessels, should be considered for laparoscopic distal pancreatectomy. Several meta-analyses showed the clear benefits of laparoscopic distal pancreatectomy over open surgery regarding blood loss, hospital stay, morbidity, and wound infection. The comparison of open surgery vs. laparoscopic surgery in patients presenting with adenocarcinoma shows the benefits of laparoscopic surgery. It is much easier to learn this technique. In this lecture, the clockwise technique is briefly demonstrated. Gravity, ports position and instrumentation are essential. The key steps of the clockwise technique are as follows: mobilization of the splenic flexure and of the proximal descending colon, dissection from lateral to medial along the lower edge of the pancreas, determination of the point of division (stapled or hand-sewn), posterior dissection, mobilization of the spleen using gravity along the superior edge of the pancreas, and removal of the specimen.
Laparoscopic distal pancreatectomy for mucinous cystadenoma
This video presents the case of a 39-year-old woman complaining of epigastric and right upper quadrant pain with dorsal irradiation and postprandial pain without nausea or vomiting. Abdominal ultrasound showed the presence of a 21mm cystic mass with multi-lobulated appearance at the tail of the pancreas. MRI confirmed the cystic nature of this tumor lesion of the tail of the pancreas, which was probably compatible with a mucinous cystadenoma (with a 23mm long axis) without communication with Wirsung’s duct. Transgastric echo-endoscopy revealed an ovoid cystic lesion of the pancreatic tail, with clean wall, measuring 19 by 10mm with small septa and a 4mm thick mural nodule without communication with the pancreatic duct. A laparoscopic left pancreatectomy was indicated because of the presence of a mucinous cystadenoma. This video demonstrates a laparoscopic distal pancreatectomy approach. A spleen-preserving distal pancreatectomy by preserving the splenic vessels (Kimura technique) was decided upon.
F Costantino, M Shahbaz, D Mutter, J Marescaux
Surgical intervention
2 years ago
1935 views
94 likes
0 comments
12:01
Laparoscopic distal pancreatectomy for mucinous cystadenoma
This video presents the case of a 39-year-old woman complaining of epigastric and right upper quadrant pain with dorsal irradiation and postprandial pain without nausea or vomiting. Abdominal ultrasound showed the presence of a 21mm cystic mass with multi-lobulated appearance at the tail of the pancreas. MRI confirmed the cystic nature of this tumor lesion of the tail of the pancreas, which was probably compatible with a mucinous cystadenoma (with a 23mm long axis) without communication with Wirsung’s duct. Transgastric echo-endoscopy revealed an ovoid cystic lesion of the pancreatic tail, with clean wall, measuring 19 by 10mm with small septa and a 4mm thick mural nodule without communication with the pancreatic duct. A laparoscopic left pancreatectomy was indicated because of the presence of a mucinous cystadenoma. This video demonstrates a laparoscopic distal pancreatectomy approach. A spleen-preserving distal pancreatectomy by preserving the splenic vessels (Kimura technique) was decided upon.
Laparoscopic enucleation of a pancreatic tumor: posterior approach
We report the case of a 55-year-old woman with a hypervascularized lesion at the posterior aspect of the pancreatic tail, which is evocative of an endocrine tumor of the pancreas. We decided to perform a laparoscopic enucleation of this tumor using a posterior approach. The patient is positioned in a right lateral decubitus. The intervention begins with the opening of the posterior mesogastrium, which allows to tilt the entire splenopancreatic block to the right. The tumor located on the posterior aspect clearly appears. An enucleation of the tumor is then performed using the monopolar cautery hook. In order to facilitate the lesion's exposure, a traction suture will be placed. This helps to expose the tumor. The inferior border of the tumor is freed from the splenic vein and the monopolar hook allows to perform a step-by-step enucleation. An intrapancreatic freeing of the lesion's deep plane is achieved using the Sonicision™ device. The tumor is placed into a bag and extracted through a port. The extemporaneous exam confirms the diagnosis of an endocrine tumor. Hemostasis is controlled. The splenopancreatic block is put back in its original anatomical position. There is no pancreatic fistula. The patient is discharged on postoperative day 5. The final diagnosis confirms a G1 endocrine tumor.
P Pessaux, R Memeo, D Ntourakis, H Jeddou, D Mutter, J Marescaux
Surgical intervention
3 years ago
1242 views
46 likes
0 comments
11:04
Laparoscopic enucleation of a pancreatic tumor: posterior approach
We report the case of a 55-year-old woman with a hypervascularized lesion at the posterior aspect of the pancreatic tail, which is evocative of an endocrine tumor of the pancreas. We decided to perform a laparoscopic enucleation of this tumor using a posterior approach. The patient is positioned in a right lateral decubitus. The intervention begins with the opening of the posterior mesogastrium, which allows to tilt the entire splenopancreatic block to the right. The tumor located on the posterior aspect clearly appears. An enucleation of the tumor is then performed using the monopolar cautery hook. In order to facilitate the lesion's exposure, a traction suture will be placed. This helps to expose the tumor. The inferior border of the tumor is freed from the splenic vein and the monopolar hook allows to perform a step-by-step enucleation. An intrapancreatic freeing of the lesion's deep plane is achieved using the Sonicision™ device. The tumor is placed into a bag and extracted through a port. The extemporaneous exam confirms the diagnosis of an endocrine tumor. Hemostasis is controlled. The splenopancreatic block is put back in its original anatomical position. There is no pancreatic fistula. The patient is discharged on postoperative day 5. The final diagnosis confirms a G1 endocrine tumor.
Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
P Vorwald, A Celdrán, M Posada, G Salcedo, T Georgiev, ML Sánchez de Molina, R Restrepo, S Ayora González
Surgical intervention
3 years ago
1770 views
44 likes
0 comments
10:03
Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
Laparoscopic distal splenopancreatectomy for a caudal cystic pancreatic lesion
We report the case of a 51-year-old woman who underwent laparoscopic left splenopancreatectomy for a caudal cystic pancreatic lesion evocative of a mucinous cyst.
The patient is placed in a right lateral supine position, legs apart. A reverse Trendelenburg position is used. Four ports are placed. After the colon has been detached from the omentum, the dissection is begun at the superior border of the pancreas. It makes it possible to dissect the splenic artery, which is placed on a tape. The dissection is carried on at the inferior border of the pancreas in order to identify the venous mesentericoportal axis. A retropancreatic passage is achieved along the mesentericoportal axis, and a tape is passed around the pancreatic isthmus, which was immediately divided by means of a stapler. The splenic vein is identified at the posterior border of the pancreas. It is dissected and placed on a tape. The splenic artery is divided between two clips. The splenic vein is divided. It is freed from attachments, then clipped, and finally divided. The distal pancreas with the spleen was dissected to perform an ‘en-bloc’ left splenopancreatectomy. The specimen is placed in a bag and extracted through a Pfannenstiel incision, with an extemporaneous exam on the slice, which allows to rule out any neoplastic infiltration. A blade is placed in the left hypochondrium with an amylase activity assay performed on postoperative day 3. The blade is extracted through the leftmost port.
P Pessaux, R Memeo, H Jeddou, X Untereiner, S Tzedakis, D Mutter, J Marescaux
Surgical intervention
4 years ago
2055 views
56 likes
0 comments
10:52
Laparoscopic distal splenopancreatectomy for a caudal cystic pancreatic lesion
We report the case of a 51-year-old woman who underwent laparoscopic left splenopancreatectomy for a caudal cystic pancreatic lesion evocative of a mucinous cyst.
The patient is placed in a right lateral supine position, legs apart. A reverse Trendelenburg position is used. Four ports are placed. After the colon has been detached from the omentum, the dissection is begun at the superior border of the pancreas. It makes it possible to dissect the splenic artery, which is placed on a tape. The dissection is carried on at the inferior border of the pancreas in order to identify the venous mesentericoportal axis. A retropancreatic passage is achieved along the mesentericoportal axis, and a tape is passed around the pancreatic isthmus, which was immediately divided by means of a stapler. The splenic vein is identified at the posterior border of the pancreas. It is dissected and placed on a tape. The splenic artery is divided between two clips. The splenic vein is divided. It is freed from attachments, then clipped, and finally divided. The distal pancreas with the spleen was dissected to perform an ‘en-bloc’ left splenopancreatectomy. The specimen is placed in a bag and extracted through a Pfannenstiel incision, with an extemporaneous exam on the slice, which allows to rule out any neoplastic infiltration. A blade is placed in the left hypochondrium with an amylase activity assay performed on postoperative day 3. The blade is extracted through the leftmost port.
Robotic distal pancreatectomy with spleen preservation with splenic vascular resection (Warshaw's technique)
We report the case of a 39-year-old woman who underwent morphological examination (CT-scan and MRI) for poorly systematized abdominal pain, which demonstrated the presence of a unilocular macrocystic lesion at the tail of the pancreas. The diagnosis established reported a mucinous cystadenoma, and a robotic distal spleen-preserving pancreatectomy was decided upon.
The dissection is initiated at the inferior border of the pancreas. Dissection has been performed at the level of the splenic hilum with freeing of the pancreatic tail. The splenic branches of the splenic vein are identified at the posterior aspect of the pancreas. These branches are freed progressively. As a result, the distal part of the pancreas is freed from the splenic hilum, and dissection will be performed from left to right. This dissection was decided upon as the lesion is located very distally. The splenic vein and the splenic artery are freed at the level of the hilum. Dissection is continued progressively to the right.
Dissection of the cyst in relation to the splenic vein is uneasy as there are several inflammatory adhesions. Dissection is then performed at the isthmic part of the pancreas. The splenic artery is dissected at the superior border of the pancreas. Dissection is then carried out at the posterior aspect of the pancreas. Considering the presence of adhesions, the operative strategy is changed. It is decided to perform a distal pancreatectomy with preservation of the spleen without vessels preservation. However, the splenic vessels are divided. Consequently, the splenic artery is ligated by a clip and divided. The distal part of the splenic artery is also ligated. Proximally, the splenic vein is dissected and divided. The distal part has also been clipped.
The distal division of arterial and venous vessels is performed. The pancreas was divided at the level of its body. The specimen is placed into a bag and extracted by means of a small Pfannenstiel incision. At the end of the procedure, the spleen appears to be well-vascularized by short vessels. The CT-scan performed on postoperative day 5 demonstrates that the spleen is well-vascularized and rules out the presence of any collection in the place left by pancreatectomy. The postoperative outcome is uneventful. There is no pancreatic fistula. The patient is discharged on postoperative day 7. Pathological findings confirm the presence of a mucinous cystadenoma without any malignancy.
P Pessaux, J Hallet, R Memeo, JB Delhorme, D Mutter, J Marescaux
Surgical intervention
4 years ago
1272 views
26 likes
0 comments
12:38
Robotic distal pancreatectomy with spleen preservation with splenic vascular resection (Warshaw's technique)
We report the case of a 39-year-old woman who underwent morphological examination (CT-scan and MRI) for poorly systematized abdominal pain, which demonstrated the presence of a unilocular macrocystic lesion at the tail of the pancreas. The diagnosis established reported a mucinous cystadenoma, and a robotic distal spleen-preserving pancreatectomy was decided upon.
The dissection is initiated at the inferior border of the pancreas. Dissection has been performed at the level of the splenic hilum with freeing of the pancreatic tail. The splenic branches of the splenic vein are identified at the posterior aspect of the pancreas. These branches are freed progressively. As a result, the distal part of the pancreas is freed from the splenic hilum, and dissection will be performed from left to right. This dissection was decided upon as the lesion is located very distally. The splenic vein and the splenic artery are freed at the level of the hilum. Dissection is continued progressively to the right.
Dissection of the cyst in relation to the splenic vein is uneasy as there are several inflammatory adhesions. Dissection is then performed at the isthmic part of the pancreas. The splenic artery is dissected at the superior border of the pancreas. Dissection is then carried out at the posterior aspect of the pancreas. Considering the presence of adhesions, the operative strategy is changed. It is decided to perform a distal pancreatectomy with preservation of the spleen without vessels preservation. However, the splenic vessels are divided. Consequently, the splenic artery is ligated by a clip and divided. The distal part of the splenic artery is also ligated. Proximally, the splenic vein is dissected and divided. The distal part has also been clipped.
The distal division of arterial and venous vessels is performed. The pancreas was divided at the level of its body. The specimen is placed into a bag and extracted by means of a small Pfannenstiel incision. At the end of the procedure, the spleen appears to be well-vascularized by short vessels. The CT-scan performed on postoperative day 5 demonstrates that the spleen is well-vascularized and rules out the presence of any collection in the place left by pancreatectomy. The postoperative outcome is uneventful. There is no pancreatic fistula. The patient is discharged on postoperative day 7. Pathological findings confirm the presence of a mucinous cystadenoma without any malignancy.
Single stage diagnosis and treatment by EUS and ERCP of a pancreatic stone causing an acute pancreatitis
Biliopancreatic stones are the ‘primum movens’ of acute pancreatitis. Pure pancreatic stones are rare. However, when present, they are the main cause of acute obstruction of the main pancreatic duct. Conversely, when present in chronic pancreatitis, they are mostly responsible for pancreatic glandular insufficiency. Medical treatment, radiologic evaluation (by MRI or CT-scan), and therapeutic endoscopy constitute the standard of care (SOC).
Here, we report the case of a 25-year-old man, admitted for upper middle abdominal pain and hyperamylasemia, without anomalies in liver function tests, and who underwent biliopancreatic EUS. A pancreatic stone was diagnosed and immediately treated by endoscopic pancreatic sphincterotomy and extraction.
Gf Donatelli, B Meduri
Surgical intervention
4 years ago
1146 views
41 likes
0 comments
05:10
Single stage diagnosis and treatment by EUS and ERCP of a pancreatic stone causing an acute pancreatitis
Biliopancreatic stones are the ‘primum movens’ of acute pancreatitis. Pure pancreatic stones are rare. However, when present, they are the main cause of acute obstruction of the main pancreatic duct. Conversely, when present in chronic pancreatitis, they are mostly responsible for pancreatic glandular insufficiency. Medical treatment, radiologic evaluation (by MRI or CT-scan), and therapeutic endoscopy constitute the standard of care (SOC).
Here, we report the case of a 25-year-old man, admitted for upper middle abdominal pain and hyperamylasemia, without anomalies in liver function tests, and who underwent biliopancreatic EUS. A pancreatic stone was diagnosed and immediately treated by endoscopic pancreatic sphincterotomy and extraction.
Laparoscopic central pancreatectomy for insulinoma
We report the case of a 43-year-old male patient who was diagnosed with insulinoma and had a robotic enucleation of an isthmic pancreatic tumor in November 2012. However, the patient presents with clinical recurrences of hypoglycemia 18 months later. Re-evaluation studies demonstrated a local recurrence. A laparoscopic central pancreatectomy was indicated. The procedure started with the opening of the lesser sac. The splenic vessels were dissected and controlled. A retropancreatic passage along the venous mesenterico-portal axis was performed. Ultrasonography was carried out to assess the pancreatic recurrence area. The pancreas isthmus was transected. A pancreaticogastric anastomosis was performed at the posterior aspect of the stomach. The resected specimen confirms the recurrence of an insulinoma, which has been entirely removed.
P Pessaux, J Teyssedou, D Ntourakis, M Vix, J Marescaux
Surgical intervention
4 years ago
1273 views
30 likes
0 comments
09:21
Laparoscopic central pancreatectomy for insulinoma
We report the case of a 43-year-old male patient who was diagnosed with insulinoma and had a robotic enucleation of an isthmic pancreatic tumor in November 2012. However, the patient presents with clinical recurrences of hypoglycemia 18 months later. Re-evaluation studies demonstrated a local recurrence. A laparoscopic central pancreatectomy was indicated. The procedure started with the opening of the lesser sac. The splenic vessels were dissected and controlled. A retropancreatic passage along the venous mesenterico-portal axis was performed. Ultrasonography was carried out to assess the pancreatic recurrence area. The pancreas isthmus was transected. A pancreaticogastric anastomosis was performed at the posterior aspect of the stomach. The resected specimen confirms the recurrence of an insulinoma, which has been entirely removed.
Laparoscopic spleen-preserving distal pancreatectomy for mucinous cystadenoma (Warshaw’s technique)
The video presents the case of a surgical procedure performed in a 58-year old woman presenting with mucinous cystadenoma in the left pancreas. The patient complained of early satiety and her CT-scan demonstrated the existence of a huge cystic tumor replacing her pancreatic body and tail. The tumor involved the splenic vein and artery, resulting in a left segmental portal hypertension. Preoperative CT-scan showed that collaterals from the short gastric vessels maintained splenic vascularization.
A spleen-preserving distal pancreatectomy, sacrificing splenic vessels, according to Warshaw’s technique was decided upon.
Fa Madureira, Fe Madureira, D Madureira
Surgical intervention
4 years ago
3047 views
52 likes
0 comments
10:43
Laparoscopic spleen-preserving distal pancreatectomy for mucinous cystadenoma (Warshaw’s technique)
The video presents the case of a surgical procedure performed in a 58-year old woman presenting with mucinous cystadenoma in the left pancreas. The patient complained of early satiety and her CT-scan demonstrated the existence of a huge cystic tumor replacing her pancreatic body and tail. The tumor involved the splenic vein and artery, resulting in a left segmental portal hypertension. Preoperative CT-scan showed that collaterals from the short gastric vessels maintained splenic vascularization.
A spleen-preserving distal pancreatectomy, sacrificing splenic vessels, according to Warshaw’s technique was decided upon.
Laparoscopic extended middle duodenal-preserving pancreatectomy: laparoscopic Beger procedure
This is the case of a 45-year-old woman (BMI of 19) who underwent a totally laparoscopic middle pancreatectomy for pancreatic incidentaloma. Preoperative work-up included abdominal ultrasound examination, CT-scan, MRI, and OctreoScan which demonstrated a hyperdense lesion in the pancreatic neck. Endoscopic ultrasound (EUS) allowed to perform a fine-needle aspiration biopsy (FNAB) of the lesion. Histopathological evaluation of the specimen showed a moderately differentiated Non-functioning Pancreatic Neuroendocrine Neoplasms (NF-PanNENs). Laparoscopic US indicated the necessity to perform pancreatic resection. During the intervention, a Roux-en-Y jejunal loop has been interposed using the Longmire-Mouchet reconstruction method.
E Falco, S Berti, E Francone, C Eretta, P Bonfante
Surgical intervention
5 years ago
1970 views
18 likes
1 comment
15:42
Laparoscopic extended middle duodenal-preserving pancreatectomy: laparoscopic Beger procedure
This is the case of a 45-year-old woman (BMI of 19) who underwent a totally laparoscopic middle pancreatectomy for pancreatic incidentaloma. Preoperative work-up included abdominal ultrasound examination, CT-scan, MRI, and OctreoScan which demonstrated a hyperdense lesion in the pancreatic neck. Endoscopic ultrasound (EUS) allowed to perform a fine-needle aspiration biopsy (FNAB) of the lesion. Histopathological evaluation of the specimen showed a moderately differentiated Non-functioning Pancreatic Neuroendocrine Neoplasms (NF-PanNENs). Laparoscopic US indicated the necessity to perform pancreatic resection. During the intervention, a Roux-en-Y jejunal loop has been interposed using the Longmire-Mouchet reconstruction method.
Tips 'n tricks: cholecystectomy: antegrade approach for difficult dissection
Today, laparoscopic cholecystectomy is a routinely performed surgical intervention. In certain cases, the identification of Calot’s triangle may be difficult due to adhesions or inflammatory infiltrations of adjacent structures. Hydrodissection can allow for an atraumatic dissection but in more complex cases, an antegrade freeing of the gallbladder should be envisaged.
Here we present the case of a man benefiting from a difficult laparoscopic cholecystectomy for a pancreatitis with common bile duct stone migration. The flag technique, with an antegrade freeing, must be applied in order to complete the procedure laparoscopically.
L Marx, C Hild, J Leroy, J Marescaux
Surgical intervention
5 years ago
4746 views
75 likes
8 comments
06:50
Tips 'n tricks: cholecystectomy: antegrade approach for difficult dissection
Today, laparoscopic cholecystectomy is a routinely performed surgical intervention. In certain cases, the identification of Calot’s triangle may be difficult due to adhesions or inflammatory infiltrations of adjacent structures. Hydrodissection can allow for an atraumatic dissection but in more complex cases, an antegrade freeing of the gallbladder should be envisaged.
Here we present the case of a man benefiting from a difficult laparoscopic cholecystectomy for a pancreatitis with common bile duct stone migration. The flag technique, with an antegrade freeing, must be applied in order to complete the procedure laparoscopically.
Laparoscopic left pancreatectomy with spleen preservation for multiple neuroendocrine tumors
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.
B Dallemagne, D Mutter, L Soler, J Marescaux
Surgical intervention
5 years ago
2608 views
76 likes
0 comments
35:52
Laparoscopic left pancreatectomy with spleen preservation for multiple neuroendocrine tumors
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.
Single incision laparoscopic gastrojejunal bypass with intraoperative ultrasonography for obstructive pancreatic head tumor
Background: Pancreatic head tumors can be diagnosed immediately as symptomatic although the biliary tract is not involved. Single incision laparoscopy can be proposed as a valid option to allow an early beginning of neo-adjuvant chemotherapy.

Video: A 56-year-old man was admitted to hospital for vomiting and weight loss. Preoperative work-up showed the presence of an advanced and obstructive pancreatic head adenocarcinoma, not interesting the biliary tract. A laparoscopic gastro-jejunal bypass with staging laparoscopy, through a transumbilical single-access, was proposed to the patient. The technique consisted in the insertion of an 11mm reusable trocar, two 6mm flexible reusable trocars, and curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany) through the same umbilical incision. The procedure started with the exploration of the parietal peritoneum, lavage of the cavity, opening of the lesser sac for perioperative ultrasonography, and ended with linear mechanical side-to-side gastrojejunostomy.

Results: The obstructive status of the patient resolved during the postoperative course and the patient started neo-adjuvant chemotherapy after 10 days.

Conclusions: Single incision laparoscopic gastrojejunostomy for obstructive pancreatic head tumor, after staging laparoscopy including perioperative ultrasonography, permits the resolution of the clinical status as well as an early beginning of neo-adjuvant chemotherapy.
G Dapri
Surgical intervention
5 years ago
2250 views
54 likes
0 comments
06:40
Single incision laparoscopic gastrojejunal bypass with intraoperative ultrasonography for obstructive pancreatic head tumor
Background: Pancreatic head tumors can be diagnosed immediately as symptomatic although the biliary tract is not involved. Single incision laparoscopy can be proposed as a valid option to allow an early beginning of neo-adjuvant chemotherapy.

Video: A 56-year-old man was admitted to hospital for vomiting and weight loss. Preoperative work-up showed the presence of an advanced and obstructive pancreatic head adenocarcinoma, not interesting the biliary tract. A laparoscopic gastro-jejunal bypass with staging laparoscopy, through a transumbilical single-access, was proposed to the patient. The technique consisted in the insertion of an 11mm reusable trocar, two 6mm flexible reusable trocars, and curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany) through the same umbilical incision. The procedure started with the exploration of the parietal peritoneum, lavage of the cavity, opening of the lesser sac for perioperative ultrasonography, and ended with linear mechanical side-to-side gastrojejunostomy.

Results: The obstructive status of the patient resolved during the postoperative course and the patient started neo-adjuvant chemotherapy after 10 days.

Conclusions: Single incision laparoscopic gastrojejunostomy for obstructive pancreatic head tumor, after staging laparoscopy including perioperative ultrasonography, permits the resolution of the clinical status as well as an early beginning of neo-adjuvant chemotherapy.
Full laparoscopic pancreaticoduodenectomy for malignant ampulloma
In the first description of Laparoscopic PancreaticoDuodenectomy (LPD) by Gagner and Pomp in 1994, the authors reported the technical feasibility of the procedure, but questioned its advantages as compared with the open approach. Recent reports on large series of LPD demonstrated that the procedure might not only be feasible, but that it might have advantages as compared with open pancreaticoduodenectomy. Blood loss, ICU length of stay and overall hospital length of stay were shorter in the LPD group at the cost of significantly higher operative times. This video demonstrates a full LPD performed for a malignant ampulloma. All major steps of the procedure are extensively and clearly demonstrated.
A Talvane Torres de Oliveira, C Lacerda, PA Bertulucci
Surgical intervention
5 years ago
7292 views
75 likes
3 comments
40:39
Full laparoscopic pancreaticoduodenectomy for malignant ampulloma
In the first description of Laparoscopic PancreaticoDuodenectomy (LPD) by Gagner and Pomp in 1994, the authors reported the technical feasibility of the procedure, but questioned its advantages as compared with the open approach. Recent reports on large series of LPD demonstrated that the procedure might not only be feasible, but that it might have advantages as compared with open pancreaticoduodenectomy. Blood loss, ICU length of stay and overall hospital length of stay were shorter in the LPD group at the cost of significantly higher operative times. This video demonstrates a full LPD performed for a malignant ampulloma. All major steps of the procedure are extensively and clearly demonstrated.
Laparoscopic splenopancreatectomy for a solid pseudopapillary pancreatic tumor
The solid pseudopapillary tumor of the pancreas, also known as Frantz’s tumor, is an uncommon occurrence usually seen in younger women. It is usually of low grade malignity and most patients have no recurrence after successful surgical resection.
In the last few years, laparoscopic approach to resection procedures for benign pathologies or low-grade malignancies of the pancreas has been increasingly used. The traditional surgical approach to the distal pancreas requires large abdominal incisions because of the deep position of the gland, and entails possible postoperative complications such as wound infections and incisional hernia.
In this video, we present a laparoscopic distal pancreatectomy with splenectomy for a localized tumor of the tail of the pancreas. It shows some steps, which could simplify the technique and prevent some complications as bleeding or postoperative fistula.
J Torres Bermúdez, FC Becerra García, G Sánchez de la Villa, M Montoya Tabares, F González Sánchez, R Nehme, AA Carrillo Sánchez, JL Martín
Surgical intervention
8 years ago
7218 views
112 likes
0 comments
14:01
Laparoscopic splenopancreatectomy for a solid pseudopapillary pancreatic tumor
The solid pseudopapillary tumor of the pancreas, also known as Frantz’s tumor, is an uncommon occurrence usually seen in younger women. It is usually of low grade malignity and most patients have no recurrence after successful surgical resection.
In the last few years, laparoscopic approach to resection procedures for benign pathologies or low-grade malignancies of the pancreas has been increasingly used. The traditional surgical approach to the distal pancreas requires large abdominal incisions because of the deep position of the gland, and entails possible postoperative complications such as wound infections and incisional hernia.
In this video, we present a laparoscopic distal pancreatectomy with splenectomy for a localized tumor of the tail of the pancreas. It shows some steps, which could simplify the technique and prevent some complications as bleeding or postoperative fistula.
Laparoscopic distal pancreatectomy with spleen and vessel preservation
This is the case of a female patient presenting with a 12mm endocrine tumor located at the pancreatic isthmus. To manage this case, a distal pancreatectomy is decided upon. This tumor measures 16mm in its transverse diameter and it is located just above the portal vein. The CT-scan and its 3D reconstruction helps us to plan the surgical intervention. The whole pancreas along with the splenic vessels (splenic vein and artery) are reconstructed. The objective is to precisely locate the tumor in order to determine the resection modalities. A distal pancreatectomy with preservation of the splenic vessels is therefore decided upon.
D Mutter, L Soler, J Marescaux
Surgical intervention
9 years ago
1707 views
163 likes
0 comments
17:42
Laparoscopic distal pancreatectomy with spleen and vessel preservation
This is the case of a female patient presenting with a 12mm endocrine tumor located at the pancreatic isthmus. To manage this case, a distal pancreatectomy is decided upon. This tumor measures 16mm in its transverse diameter and it is located just above the portal vein. The CT-scan and its 3D reconstruction helps us to plan the surgical intervention. The whole pancreas along with the splenic vessels (splenic vein and artery) are reconstructed. The objective is to precisely locate the tumor in order to determine the resection modalities. A distal pancreatectomy with preservation of the splenic vessels is therefore decided upon.
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.
B Dallemagne, S Perretta, L Soler, J Marescaux
Surgical intervention
9 years ago
1004 views
47 likes
0 comments
19:27
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.
Duodenopancreatectomy: potentialities of the laparoscopic approach in the mobilization, dissection, and resection stages of the procedure
This video demonstrates the laparoscopic approach of a cephalic
duodenopancreatectomy in a 70-year-old patient presenting with an
adenocarcinoma of the pancreatic head. Using 4 ports, the duodenum is completely detached. The unciform process is prepared posteriorly by dissecting the superior mesenteric artery and the portal vein in its right lower section. A total lymph node resection and an antrectomy have been performed, followed by the resection of the pancreatic body. Last but not least, the small bowel is divided and the duodenum is de-crossed. The dissection shows the different steps of the procedure with extra details.
B Ghavami
Surgical intervention
9 years ago
13334 views
192 likes
5 comments
17:55
Duodenopancreatectomy: potentialities of the laparoscopic approach in the mobilization, dissection, and resection stages of the procedure
This video demonstrates the laparoscopic approach of a cephalic
duodenopancreatectomy in a 70-year-old patient presenting with an
adenocarcinoma of the pancreatic head. Using 4 ports, the duodenum is completely detached. The unciform process is prepared posteriorly by dissecting the superior mesenteric artery and the portal vein in its right lower section. A total lymph node resection and an antrectomy have been performed, followed by the resection of the pancreatic body. Last but not least, the small bowel is divided and the duodenum is de-crossed. The dissection shows the different steps of the procedure with extra details.
Laparoscopic splenopancreatectomy assisted by augmented reality for pancreatic cancer
Soper et al. in 1994 were able to establish the safety and efficacy of laparoscopic distal pancreatectomy in an animal model, with no evidence of pancreatic leaks or fistulas. Later, in 1996, Cuschieri et al. described the technique they used to perform laparoscopic distal 70–80% pancreatectomy with en-bloc splenectomy in a group of five patients with intractable pain due to chronic pancreatitis. The authors demonstrated that this operation can be performed laparoscopically within an acceptable operating time and without major complications with advantages that include smaller incisions, less pain, and shorter postoperative recovery.
Identification of anatomical landmarks is crucial for this kind of procedure expecially when treating cancer. Augmented reality is a new tool to improve oncological safety, confirming the ideal dissection plane and anatomical landmarks, and to maximize functional preservation. The objective of this video is to demonstrate how to perform a splenopancreatectomy with removal of pancreatic cancer while keeping sufficient safety margins. Augmented reality is used in order to clearly identify the position of the anatomical landmarks: the splenic vein and artery, as well as the exact position of the tumor so that a sufficient resection margin can be identified.
D Mutter, J Marescaux, L Soler
Surgical intervention
10 years ago
1322 views
40 likes
0 comments
18:27
Laparoscopic splenopancreatectomy assisted by augmented reality for pancreatic cancer
Soper et al. in 1994 were able to establish the safety and efficacy of laparoscopic distal pancreatectomy in an animal model, with no evidence of pancreatic leaks or fistulas. Later, in 1996, Cuschieri et al. described the technique they used to perform laparoscopic distal 70–80% pancreatectomy with en-bloc splenectomy in a group of five patients with intractable pain due to chronic pancreatitis. The authors demonstrated that this operation can be performed laparoscopically within an acceptable operating time and without major complications with advantages that include smaller incisions, less pain, and shorter postoperative recovery.
Identification of anatomical landmarks is crucial for this kind of procedure expecially when treating cancer. Augmented reality is a new tool to improve oncological safety, confirming the ideal dissection plane and anatomical landmarks, and to maximize functional preservation. The objective of this video is to demonstrate how to perform a splenopancreatectomy with removal of pancreatic cancer while keeping sufficient safety margins. Augmented reality is used in order to clearly identify the position of the anatomical landmarks: the splenic vein and artery, as well as the exact position of the tumor so that a sufficient resection margin can be identified.
Totally laparoscopic duodenal pancreatectomy for cancer
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. Laparoscopic proximal pancreatectomies for cancer with or without duodenum preservation remain controversial. Although a laparoscopic pancreaticoduodenectomy is technically feasible, laparoscopic reconstruction after proximal pancreatectomies is not yet generally practicable but limited to personal experiences of highly skilled surgeons.
This interesting video shows all steps and landmarks of a totally laparoscopic duodenopancreatectomy for cancer performed by a very experienced surgeon.
F Corcione, J Marescaux
Surgical intervention
10 years ago
8748 views
36 likes
1 comment
21:13
Totally laparoscopic duodenal pancreatectomy for cancer
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. Laparoscopic proximal pancreatectomies for cancer with or without duodenum preservation remain controversial. Although a laparoscopic pancreaticoduodenectomy is technically feasible, laparoscopic reconstruction after proximal pancreatectomies is not yet generally practicable but limited to personal experiences of highly skilled surgeons.
This interesting video shows all steps and landmarks of a totally laparoscopic duodenopancreatectomy for cancer performed by a very experienced surgeon.
Laparoscopic radical antegrade pancreatosplenectomy
Benign inflammatory lesions, cystic neoplasms, and neuro-endocrine tumours in the body and tail of the pancreas are considered good indications for laparoscopic distal pancreatectomy and/or en-bloc pancreatosplenectomy. Laparoscopic resection of malignant neoplasms has raised concern about the radicality of resection and oncological outcomes.
This video demonstrates the technique of laparoscopic radical antegrade pancreatosplenectomy (lap-RAP), which achieves a radical resection with clear circumferential margins. The resection proceeds from right to left to include a coeliac lymphadenectomy, early division of the splenic artery, splenic vein and neck of pancreas, and medial to lateral mobilization of the pancreas posterior to Gerota's fascia to ensure an adequate posterior oncological clearance.
Lap-RAP extends the benefits of laparoscopic pancreatectomy to include malignant lesions in the body and tail of the pancreas.
This video is recommended for experienced laparoscopic surgeons.
I Tait, FM Polignano, GD Adamson
Surgical intervention
10 years ago
3244 views
92 likes
0 comments
09:51
Laparoscopic radical antegrade pancreatosplenectomy
Benign inflammatory lesions, cystic neoplasms, and neuro-endocrine tumours in the body and tail of the pancreas are considered good indications for laparoscopic distal pancreatectomy and/or en-bloc pancreatosplenectomy. Laparoscopic resection of malignant neoplasms has raised concern about the radicality of resection and oncological outcomes.
This video demonstrates the technique of laparoscopic radical antegrade pancreatosplenectomy (lap-RAP), which achieves a radical resection with clear circumferential margins. The resection proceeds from right to left to include a coeliac lymphadenectomy, early division of the splenic artery, splenic vein and neck of pancreas, and medial to lateral mobilization of the pancreas posterior to Gerota's fascia to ensure an adequate posterior oncological clearance.
Lap-RAP extends the benefits of laparoscopic pancreatectomy to include malignant lesions in the body and tail of the pancreas.
This video is recommended for experienced laparoscopic surgeons.
Laparoscopic spleno-pancreatectomy for cancer
Laparoscopic spleno-pancreatic resection performed for adenocarcinoma in the tail of the pancreas. This case demonstrates how a complex resection can be undertaken laparoscopically using a stepwise approach. Difficulty was encountered with division of the pancreas and the management of this problem is discussed.

The surgeon stands between the patient's legs with the table in the reverse Trendelenburg position. The authors place three 10-mm ports across the upper abdomen with additional 5-mm ports in the left subcostal epigastric area. The camera is placed in the supraumbilical port. The laparascopic approach provides superior visualization, and tactile assessment of the pancreas. Mobility of the tumor is important to determine feasibility of resection. Laparoscopic ultrasound can delineate the tumor and surrounding structures.
B Dallemagne, L Soler, J Marescaux
Surgical intervention
12 years ago
5791 views
24 likes
0 comments
14:35
Laparoscopic spleno-pancreatectomy for cancer
Laparoscopic spleno-pancreatic resection performed for adenocarcinoma in the tail of the pancreas. This case demonstrates how a complex resection can be undertaken laparoscopically using a stepwise approach. Difficulty was encountered with division of the pancreas and the management of this problem is discussed.

The surgeon stands between the patient's legs with the table in the reverse Trendelenburg position. The authors place three 10-mm ports across the upper abdomen with additional 5-mm ports in the left subcostal epigastric area. The camera is placed in the supraumbilical port. The laparascopic approach provides superior visualization, and tactile assessment of the pancreas. Mobility of the tumor is important to determine feasibility of resection. Laparoscopic ultrasound can delineate the tumor and surrounding structures.