Evaluating the relationships between splenic artery and pancreatic parenchyma using three dimensional CT for laparoscopic distal pancreatectomy

Abstract

Background: Isolating the root of splenic artery (SPA) is essential for conventional distal pancreatectomy, while remains challenging in laparoscopic procedure due to the complexity in anatomical variation around SPA. This study aimed to investigate the usefulness of preoperative evaluation of the relationships between SPA and pancreatic parenchyma using 3D-CT. Methods: A total of 104 patients who underwent distal pancreatectomy (74 with laparoscopic procedure and 30 with open procedure) were evaluated. The relationship between SPA and pancreatic parenchyma was classified into two types with preoperative 3D-CT, namely “Buried type” and “Non-buried type”. Video clips of 50 patients were reviewed to investigate whether this classification would be related with the difficulty of isolating the SPA. In addition, the distribution of dorsal pancreatic artery (DPA) was also evaluated. Results: DPA from SPA was identified in 94 (91.3%) patients and the number was four in one patient, three in 8, two in 29, and one in 56. Fifty-eight (55.8%) patients had DPA within 30mm of the root of the SPA. Of the 50 assessed patients who underwent LDP, there were “Buried-type” in 30 (60.0%) and “Non-buried” type in 20 (40.0%). The median time for isolating SPA in “Buried-type” (25.8 min; range, 4.0 to 101) was significantly longer than that in “Non-buried type” (7.0 min, range, 1.0 to 27.0) (P< 0.001). Conclusion: Preoperative 3D anatomical image analysis around pancreas is practical to predict the difficulty of isolating the root of SPA and to provide the safety of the procedure.