Lateral approach for laparoscopic splenic vessel-preserving distal pancreatectomy

Nakamura, Masafumi; Nagayoshi, Yosuke; Kono, Hiroshi; Mori, Yasuhisa; Ohtsuka, Takao; Takahata, Shunichi; Shimizu, Shuji; Tanaka, Masao

doi:10.1016/j.surg.2011.05.014

Cited by 44 publications

(47 citation statements)

References 19 publications

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“…However, the isolation of the splenic artery and vein from the pancreatic parenchyma in the pancreatic body is difficult, especially when performing LSVPDP. Nakamura et al [8] reported a lateral approach for safely performing LSVPDP. They began separation of the pancreatic gland from the retroperitoneum, and separation of the splenic vessels Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Splenic vessel-preserving distal pancreatectomy has been widely performed because the spleen plays an im-portant role in the immune system [8,9] . However, laparoscopic splenic vessel-preserving distal pancreatectomy (LSVPDP) also remains technically demanding because the whole splenic artery and vein need to be isolated from the pancreatic parenchyma.…”

Section: Introductionmentioning

confidence: 99%

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The Straightened Splenic Vessels Method Improves Surgical Outcomes of Laparoscopic Distal Pancreatectomy

Nagakawa

Sahara²,

Hosokawa³

et al. 2017

Dig Surg

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Background: In laparoscopic distal pancreatectomy (LDP), isolating the splenic artery and vein requires advanced techniques. This study aimed to assess the efficacy of a novel method termed the ‘straightened splenic vessels' (SSV) method for isolating the splenic vessels in LDP. Methods: In SSV, to adjust the instrument axis, the splenic artery was straightened by grasping 2 points of its nerve sheath. Then, the layer between the splenic artery's nerve sheath and the pancreatic parenchyma was dissected. Next, the pancreas was mobilized from body to tail, and the splenic vein was straightened by 3-point retraction before isolation. To evaluate this method's efficacy, we investigated 51 patients who underwent LDP. Results: In 39 patients who underwent LDP with splenectomy, the mean operating time was significantly shorter in the SSV group than in the conventional group (p = 0.004). In 12 patients who underwent LDP with preserving the splenic vessels, the mean intraoperative blood loss in the SSV group was 27.6 ml, which was significantly lower than that in the conventional group (p = 0.012). Conclusion: This method may be applied as a standard procedure with little blood loss and short operation time for LDP. Larger prospective studies are needed to further evaluate the feasibility.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Straightened Splenic Vessels Method Improves Surgical Outcomes of Laparoscopic Distal Pancreatectomy

Nagakawa

Sahara²,

Hosokawa³

et al. 2017

Dig Surg

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“…Le contrôle premier de l'artère splénique à son origine est aisé, limitant ainsi les pertes sanguines au cours de la dissection, tandis que le contrôle de la veine splénique à sa terminaison au bord gauche de l'axe mésentérico-porte est facilité par l'absence de collatérale veineuse antérieure lors de la création du tunnel isthmique rétro-pancréatique pré-veineux. 5 Fox et al [28] 12 Fernandez-Cruz (pathologies bénignes) 6 Limongelli et al [29] 6 Par rapport à la voie antérograde, la voie rétrograde a pour avantage de faciliter la dissection de la veine splénique à son origine dans le hile de la rate et de favoriser pour certaines équipes asiatiques la conservation des vaisseaux spléniques [58].…”

Section: Avantages Et Inconvénientsunclassified

“…3). Il peut être parfois nécessaire de la contrôler au niveau K. Mohkam et al du hile splénique puis de finir sa dissection dans le sens du flux sanguin, comme l'ont décrit Nakamura et al Pour ces auteurs, cette technique permettrait de diminuer les échecs de conservation des vaisseaux (0 vs 53 %) ainsi que les pertes sanguines (125 mL vs 1025 mL, p = 0,007) [58].…”

Section: Veine Spléniqueunclassified

La pancréatectomie gauche laparoscopique peut-elle être standardisée ? Synthèse des ateliers de printemps de l’ACHBT 2013

Mohkam

Farges

Pruvot

et al. 2015

Journal de Chirurgie Viscérale

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Pancréatectomie gauche ; Splénopancréatectomie gauche ; Laparoscopie ; Conservation splénique ; Conservation des vaisseaux spléniques Résumé La pancréatectomie gauche (PG) par abord laparoscopique est aujourd'hui une procédure validée : 25 études rétrospectives comparant laparotomie et laparoscopie ont démontré la faisabilité de cette voie d'abord pour les lésions bénignes et malignes localement peu avancées. Cependant, ces études rapportent de nombreuses variantes techniques et le but de cette mise au point est de déterminer si une standardisation peut être proposée pour cette procédure. À partir des données de la littérature et de l'expérience française de l'Association de chirurgie hépato-biliaire et de transplantation hépatique (ACHBT), il paraît licite d'établir certaines recommandations, telles que le contrôle premier de l'artère splénique, l'utilisation d'agrafeuses linéaires pour la section parenchymateuse pancréatique, le contrôle de la veine splénique à sa terminaison et/ou à son origine, la ligature et/ou section systématique de l'artère en cas de ligature de la veine splénique, et en fonction des conditions locales, la conservation des vaisseaux spléniques lorsqu'une conservation splénique est envisagée. Les données actuelles DOI de l'article original : http://dx. ARTICLE IN PRESSModele + 2 K. Mohkam et al. ne permettent en revanche pas d'émettre des recommandations concernant le site idéal de section pancréatique, le type d'installation, et le sens de dissection pancréatique, qui reste affaire d'école. Le contrôle de la veine splénique reste le point critique de cette intervention et va conditionner la stratégie peropératoire. Summary Laparoscopic distal pancreatectomy is currently a commonly performed procedure. Twenty-five retrospective studies comparing laparotomy and laparoscopy have dealt with the feasibility of this approach for localized benign and malignant tumors. However, these studies report several different techniques. The aim of this review was to determine if a standardized procedure could be proposed. Based on the literature and the experience of surgeons in the French Association of Hepatobiliary Surgery and Liver Transplantation (Association Française de Chirurgie Hépato-biliaire et de Transplantation Hépatique [ACBHT]), we recommend primary control of the splenic artery, use of linear staplers for pancreatic transection, splenic vein control either at its end or its origin, and, depending on local conditions, preservation of the splenic vessels when splenic preservation is envisioned. Current data do not allow establishment of any definitive recommendations as to the ideal site of pancreatic transection, operative patient position, or the direction of dissection, which mainly depends on local practices. Control of the splenic vein remains the critical point of this procedure, and impacts the intra-operative strategy. Points essentiels• Le contrôle premier de l'artère splénique permet de limiter le risque hémorragique au cours de la dissection pancréatique. • Le sens de la dissectio...

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“…One recent study has detailed an approach that has some promise for reliable vessel preservation. Nakamura et al [76] described their approach to splenic-vessel-preserving LDP which features separation of the pancreas from the retroperitoneum laterally first. Their rationale is that the splenic vessels are more easily separated from the parenchyma in this manner, thus facilitating a safer retrograde dissection.…”

Section: Splenic Preservation In Laparoscopic Distal Pancreatectomymentioning

confidence: 99%

The Current State of Minimally Invasive Distal Pancreatectomy

Lee

Vollmer

2013

Curr Surg Rep

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Since its advent nearly 15 years ago, minimally invasive distal pancreatectomy has gradually increased in popularity. Numerous reports have now documented the safety and feasibility of the laparoscopic approach to left-sided pancreas resections, and large-scale comparisons have been made between the laparoscopic and open approaches regarding perioperative outcomes for both benign and malignant lesions. Furthermore, several highvolume centers have described their initial experiences with robotic distal pancreatectomy in comparison with laparoscopic and open resections. This review summarizes the literature for both laparoscopic and robotic distal pancreatectomy over the past year, highlighting novel advances. Although studies suggest that minimally invasive distal pancreatectomy is equivalent if not superior to the open approach in some respects, randomized studies are needed to best delineate the putative benefits.

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Lateral approach for laparoscopic splenic vessel-preserving distal pancreatectomy

Cited by 44 publications

References 19 publications

The Straightened Splenic Vessels Method Improves Surgical Outcomes of Laparoscopic Distal Pancreatectomy

The Straightened Splenic Vessels Method Improves Surgical Outcomes of Laparoscopic Distal Pancreatectomy

La pancréatectomie gauche laparoscopique peut-elle être standardisée ? Synthèse des ateliers de printemps de l’ACHBT 2013

The Current State of Minimally Invasive Distal Pancreatectomy

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