Laparoscopic distal pancreatomy: are we ready for a standardized technique?

This paper describes and discusses the surgical steps needed to perform a laparoscopic distal pancreatectomy. The current lack of standardization of the operative technique can account for the limited diffusion of this procedure. The issue of spleen preservation, which cannot be overemphasized, always demands an accurate surgical technique that results from proficiency both in open pancreatic surgery and advanced laparoscopy. The preservation of the splenic vessels or short gastric-vessel salvage is feasible, yet with different indications. Also, the splenic-vessels preservation procedure has two distinct technical options. The technique of occlusion of the pancreatic stump is crucial for reducing the risk of a postoperative fistula and should be tailored to the structural features of the gland at the transection line. Finally, the hand-assisted approach can provide distinctive advantages over the pure laparoscopic technique in selected circumstances.