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Updated: Jun 4, 2025

Robotic Spleen-Preserving Distal Pancreatectomy: The Warshaw and Kimura Techniques
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Laparoscopic Warshaw Procedure for Solid Pseudopapillary Neoplasms in Children.

Chirag Ram1, Katharyn Cassella2, Jan A Niec1

  • 1Vanderbilt University School of Medicine, Nashville, TN, USA.

The American Surgeon
|January 3, 2025
PubMed
Summary

Laparoscopic distal pancreatectomy using the Warshaw technique effectively preserves spleen volume in children with solid pseudopapillary neoplasms (SPNs). This spleen-preserving approach shows promising oncologic outcomes and efficient resource utilization.

Keywords:
minimally invasive surgerypancreaspediatric surgerysurgical oncology

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Area of Science:

  • Pediatric Surgery
  • Surgical Oncology
  • Abdominal Imaging

Background:

  • Solid pseudopapillary neoplasms (SPNs) in the pancreas body/tail can necessitate distal pancreatectomy.
  • Laparoscopic approaches offer minimally invasive options, potentially including spleen preservation.

Purpose of the Study:

  • To evaluate the efficacy of laparoscopic distal pancreatectomy using the Warshaw technique for spleen preservation in pediatric patients with SPN.
  • To assess oncologic outcomes and resource utilization associated with this surgical approach.

Main Methods:

  • Retrospective review of pediatric SPN patients (≤19 years) undergoing laparoscopic Warshaw procedure (January 2006-December 2023).
  • Preoperative and postoperative CT scans analyzed for tumor, pancreas, and spleen volumes using volumetric analysis.
  • Descriptive statistics to evaluate spleen salvage, oncologic control, and perioperative outcomes.

Main Results:

  • All five pediatric patients successfully underwent spleen salvage via laparoscopic Warshaw procedure.
  • Postoperative splenic volumes averaged 93.9% of preoperative size, increasing to 110.6% over time, with collateral flow enhancement.
  • All SPNs were resected with negative margins, and no recurrence was observed during a median follow-up of 407 days.
  • Procedure demonstrated low morbidity with median estimated blood loss of 100 mL, procedure length of 4.9 hours, and hospital stay of 3 days.

Conclusions:

  • Laparoscopic Warshaw technique is highly effective for spleen preservation in pediatric SPN cases.
  • This approach maintains oncologic fidelity and efficient inpatient resource use.
  • The technique supports long-term splenic volume restoration and function through collateral circulation.