Abstract
Solid pseudopapillary neoplasm (SPN) is a rare tumor of the pancreas. Laparoscopic distal pancreatectomy (DP) is a feasible and safe procedure, and successful spleen preservation rates are higher using a laparoscopic approach. We hypothesized that certain patients with SPN would be good candidates for laparoscopic surgery; however, few surgeons have reported laparoscopic DP for SPN. We discuss the preoperative assessment and surgical simulation for two SPN cases. A simulation was designed because we consider that a thorough preoperative understanding of the procedure based on three-dimensional image analysis is important for successful laparoscopic DP. We also discuss the details of the actual laparoscopic DP with or without splenic preservation that we performed for our two SPN cases. It is critical to use appropriate instruments at appropriate points in the procedure; surgical instruments are numerous and varied, and surgeons should maximize the use of each instrument. Finally, we discuss the key techniques and surgical pitfalls in laparoscopic DP with or without splenic preservation. We conclude that experience alone is inadequate for successful laparoscopic surgery.
Highlights
Epithelial neoplasms of uncertain differentiation, such as solid pseudopapillary neoplasm (SPN), pancreatoblastoma, and undifferentiated carcinoma, are rare tumors of the pancreas
The patient was a 2-yearold boy who died during an attempted pancreaticoduodenectomy
In 1970, Hamoudi et al described the ultrastructural features of the tumor, which led to its acceptance as a separate clinicopathological entity [13]
Summary
Epithelial neoplasms of uncertain differentiation, such as solid pseudopapillary neoplasm (SPN), pancreatoblastoma, and undifferentiated carcinoma, are rare tumors of the pancreas. Laparoscopic surgery for pancreatic tumors is well described [1,2,3,4,5] and certain patients with SPN are good candidates for laparoscopic surgery [6, 7]. Few surgeons have reported laparoscopic distal pancreatectomy (DP) for SPN [6,7,8]. We discuss our surgical approach using laparoscopic DP with or without preservation of the spleen for two patients with SPN, with the key techniques and pitfalls. The surgical procedures were approved by our institutional ethics committee and review board, and both patients gave written consent for publication of the details of their cases
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