Tips and tricks of splenic vessel preservation during laparoscopic distal pancreatectomy.

BACKGROUND: While a laparoscopic approach can minimize postoperative morbidity in splenic vessel preserving (SVP) distal pancreatectomy (DP), this procedure can be technically challenging. A systematic approach to SVP minimizes the chances of vascular injury and maximizes the chances of successful splenic preservation. This video demonstrates a laparoscopic DP with SVP, highlighting technical tips and tricks that optimize the chances for SVP. PATIENT: The patient is a 14-year-old male with an incidentally discovered pancreatic tail mass. CT imaging demonstrates a 4.5 cm well-circumscribed tumor with the typical solid and cystic components of a solid pseudopapillary tumor (SPPT). Since SPPT is a rare pancreatic tumor associated with excellent prognosis following surgery, upfront minimally invasive DP with SPV was considered the optimal approach in this young patient. Following successful surgery, the postoperative course was uneventful. Pathology confirmed the diagnosis of a pT3N0. SPPT with negative margins. TECHNIQUE: Here we demonstrate a systematic approach to maximize the changes of SVP in DP. This approach, as demonstrated in the video, includes optimal patient and port positioning, dissection to optimize exposure of the distal splenic vessels, techniques to minimize vascular trauma especially splenic venous trauma, as well as supplemental measures to ensure postoperative patency of splenic vessels following completion of the case.
CONCLUSIONS: This systematic approach may maximize the changes of successful SVP, while avoiding postoperative complications such as splenic infarct, left-sided portal hypertension or overwhelming post-splenectomy sepsis.