Distal pancreatic resection: technical differences between open and laparoscopic approaches

Abstract

Open distal pancreatic resection has been performed over the years for management of patients with a variety of pancreatic disorders. However, the technique is usually not performed in the same way by all surgeons. In recent years, the laparoscopic approach has been introduced with all the advantages of a minimally invasive procedure. The primary differences between the open and laparoscopic approaches are the method of access, the method of exposure, and the extent of operative trauma. The clinical advantages of the laparoscopic approach are the reduced length hospitalization, the reduction in postoperative pain, absence of wound-related complications and faster recovery.

Figure 1.

Open distal pancreatectomy with en bloc splenectomy: (1) division of the splenic artery; (2) dissection of the inferior border of the pancreas.

Figure 2.

Open distal pancreatectomy with en bloc splenectomy: (1) division of the splenic artery; (2) the spleno-pancreatic-block fully mobilized and brought over the right side of the patient; (3) the splenic vein oversewn over the portal vein; (4) transection of the pancreas using staple device.

Figure 3.

Open distal spleen-preserving distal pancreatectomy without splenic vessels preservation: (1) division of the splenic artery; (2) dissection of the inferior border of the pancreas; (3) transection, by using staple device, of the area between the distal end of the tail of the pancreas and the splenic hilum; (4) splenic vein is oversewn over the portal vein.

Figure 4.

Laparoscopic spleen-preserving distal pancreatectomy with splenic vessels preservation. The inferior border of the pancreas is dissected and the body and tail of the pancreas are completely detached from the retroperitoneum. A tunnel is created between the splenic vein and the pancreas. The pancreas is transected with a 30-mm endoscopic linear stapler.

Figure 5.

Laparoscopic spleen-preserving distal pancreatectomy with splenic vessels preservation. Transection of the neck of the pancreas with endoGIA; the tail of the pancreas is grasped and retracted anteriorly; exposure of the vascular connection between the end of the tail of the pancreas and the splenic hilum.

Figure 6.

Laparoscopic spleen-preserving distal pancreatectomy with splenic vessels preservation. The vessels connecting the end of the tail of the pancreas are ligated or coagulated with a Ligasure divice.

Figure 7.

Laparoscopic spleen-preserving distal pancreatectomy without splenic vessels preservation: (1) division of the splenic vein; (2) transection of the pancreas; (3) division of the splenic artery; (4) transection of the area between the end of the tail of the pancreas and the splenic hilum.