Inferior-Medial Approach to Laparoscopic Splenic Vessel-Preserving Distal Pancreatectomy

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Pancreatic Surgery

Background:

• Preserving splenic vessels during laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is crucial but technically challenging.
• Deep embedding of splenic vessels in pancreatic parenchyma complicates standard LSPDP techniques.
• The inferior-medial approach is proposed to address these challenges in LSPDP.

Purpose of the Study:

• To introduce and evaluate the safety and feasibility of an inferior-medial approach for laparoscopic splenic vessel-preserving distal pancreatectomy (lap-SVPDP).
• To compare the outcomes of lap-SVPDP using the inferior-medial approach versus the laparoscopic Warshaw technique (lap-WT).

Main Methods:

• A retrospective analysis of 43 patients undergoing LSPDP by a single surgeon.
• Comparison of outcomes between 26 patients who underwent lap-SVPDP with an inferior-medial approach and 17 patients who underwent lap-WT.
• Evaluation of operative time, blood loss, conversion rates, and splenic vein patency.

Main Results:

• No patient in the lap-SVPDP group required conversion to laparotomy or lap-WT.
• Operative time and intraoperative blood loss were comparable between the lap-SVPDP and lap-WT groups, despite the perceived technical complexity of lap-SVPDP.
• Splenic vein patency in the lap-SVPDP group was not inferior to that of open spleen-preserving distal pancreatectomy (SVPDP).
• Mean tumor size was significantly larger in the lap-WT group compared to the lap-SVPDP group (P=.001).

Conclusions:

• The inferior-medial approach for lap-SVPDP is a safe and feasible surgical technique.
• This approach does not lead to increased operative time or blood loss.
• It offers a viable option for spleen preservation during distal pancreatectomy.