Hand-assisted laparoscopic distal pancreatectomy for pancreatic cystadenoma.

A cystic lesion in the body of the pancreas was detected during staging workup of a 59-year-old woman with T-cell lymphoma of the tongue. After six cycles of chemotherapy the pancreatic lesion was unchanged. Suggestive ulceration of the vulva with edema appeared at the end of chemotherapy. After right vulvar excision, distal pancreatic resection with splenectomy was carried out by a hand-assisted laparoscopic technique utilizing a small muscle-splitting right lower quadrant incision. This allowed for palpation of the peritoneal cavity for evidence of tumor and allowed for safe and expeditious pancreatectomy. The pancreatic tumor was found to be a serous cystadenoma without evidence of malignancy. T-cell lymphoma was identified in the spleen and the vulva. The patient was discharged home on the fifth postoperative day and returned to normal activity within 2 weeks after operation. Two months after the surgery, computed tomography demonstrated a 3-cm pseudocyst in the region of the tail of the pancreas. As the patient was asymptomatic, this required no further therapy. Minimally invasive surgery together with hand assistance combines the advantages of both laparotomy and laparoscopy in the surgical management of selected lesions in the pancreas.