Total laparoscopic distal pancreatectomy: beyond selected patients

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Laparoscopic distal pancreatectomy (LDP) is increasingly preferred for select patients.
• Evaluating LDP feasibility and outcomes in consecutive, nonselected patients is crucial.

Purpose of the Study:

• To assess the feasibility and procedural outcomes of LDP in a series of consecutive, nonselected patients.
• To compare outcomes of LDP with and without splenic preservation.

Main Methods:

• A prospective database identified patients undergoing distal pancreatectomy over 18 months.
• A completely laparoscopic, 4-trocar technique was employed, avoiding hand-assistance.
• Key metrics included conversion rates, operative time, blood loss, transfusion needs, length of stay, and complications.

Main Results:

• Of 14 patients undergoing LDP, 4 conversions to open surgery occurred, with trends towards increased operative time, blood loss, and length of stay.
• No mortalities were observed; morbidities included pancreatic fistula, splenic abscess, and pneumonia.
• Laparoscopic distal pancreatectomy with splenic artery preservation (LDP-SAP) showed significantly reduced operative time, transfusion rates, and length of stay compared to LDP without splenic preservation.

Conclusions:

• LDP is technically feasible in nonselected patients, yielding outcomes comparable to the literature for selected cases.
• LDP-SAP demonstrates superior peri-procedural outcomes, suggesting potential for expanded indications.
• The study supports LDP as a viable option with potentially wider applicability.