Laparoscopic spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein (Kimura's procedure)

Abstract

Authors present the case of a laparoscopic spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein (Kimura's procedure). A 26-year old female patient was admitted with a neoplasm of the tail of the pancreas detected by abdominal ultrasound. Pancreatic protocol CT-scan revealed a 7 cm round-shaped tumor in the tail of the pancreas. The CT features of the lesion were suggestive for mucinous cystadenoma. Spleen-preserving laparoscopic distal pancreatectomy is considered as the first choice procedure for benign lesions located at the body or tail of the pancreas and is performed very frequently worldwide. The advantages of preservation of the spleen are related to the preserved immune function of the organ. The two main surgical techniques that have been proposed and widely adopted for spleen preserving laparoscopic distal pancreatectomy are the Warshaw (splenic vessel ligation) and Kimura (splenic vessel preservation) techniques. The procedure was complicated due to the large size of the lesion and firm adhesions between the vessels and the tumor. Nevertheless the splenic vessels were successfully preserved after clipping all the branches of the splenic vein and artery. No significant bleeding occurred. The estimated blood loss was 50 ml. The operation time was 210 minutes. The postoperative course was complicated by a postoperative pancreatic fistula (POPF) grade B (according to the ISGPF classification), which was managed successfully using interventional percutaneous drainage. Final histopathological examination confirmed mucinous cystadenoma of the tail of the pancreas. The patient was discharged on postoperative day 14 with external drainage tube, which was removed in three weeks after amylase level control in an outpatient clinic. The purpose of the video is to demonstrate our experience in performing Kimura's procedure.