Laparoscopic distal pancreatectomy: fusion of clockwise and Warshaw technique

Abstract

Purpose: Distal pancreatectomy is the standard procedure for tumor of the body and tail of the pancreas. Spleen preserving is possible in case of non-adenocarcinoma tumors. Laparoscopic approach is nowadays worldwide accepted and replicable. To improve the technique, several authors tried to perform some steps in order to facilitate the procedure and to make sure on oncological plan. In our video, we present a fusion of two technique useful in non-adenocarcinoma tumors, based on new laparoscopic and old open approach: a fusion of Clockwise and Warshaw technique. Method: Our technique, based on eleven steps, first follow the embryological retroperitoneal plan of dissection from left to right and from bottom to top to expose the pancreatic area according to Warshaw technique. Second, it include the section of pancreatic body and the liberation of distal pancreas from splenic vessels until to splenic hilum, according to Warshaw technique. Results: Mix approach can make easy the isolation of pancreatic area via avascular dissection and distal pancreatectomy via spleen preserving. Conclusion: This approach easy and replicable can be taken in consideration for all non-adenocarcinoma-tumor: for adenocarcinoma tumor the retro pancreatic dissection plan for lymph node dissection can be follow the Radical Anterograde Modular Pancreatospenectomy criteria.