Abstract
BackgroundSpleen-preserving laparoscopic distal pancreatectomy is technically challenging. New surgical robotic systems are now available and show promising outcomes but were very recently implemented in China.MethodsSeven patients underwent laparoscopic distal pancreatectomy using the da Vinci Robotic System (RDP) for benign or borderline malignant pancreatic tumors. Spleen preservation rate, blood loss, and operative complications were assessed.ResultsMean age was 44.6 ± 13.7 years. Surgery was uneventful in all patients, without conversion to laparotomy. The surgical time (including anesthesia induction, robot docking, operation, and postoperative awaking time) was 460 ± 154 min, while the operation time was 368 ± 126 min. Blood losses were 200 ± 110 mL. The minor (Clavien I+II) complication rate was 14.3 %, and the major (Clavien III+IV) complication rate was 14.3 %, including hemorrhage and pancreatic leakage. The spleen preservation rate was 100 %. All complications were successfully managed and cured. Intraoperative laparoscopic ultrasound examination successfully identified the correct surgical resection margins. Mean postoperative hospitalization was 8.7 ± 6.6 days. No patient had to undergo a second pancreas surgery. Patients were followed up for a median of 6.8 months (range, 6 to 22 months). All patients survived and reported few discomforts.ConclusionsRDP is feasible and allows the preservation of the splenic vessels.
Highlights
Spleen-preserving laparoscopic distal pancreatectomy is technically challenging
Spleen-preserving laparoscopic distal pancreatectomy is currently accepted for the treatment of benign and borderline malignant pancreas tumors located distally
robotic distal pancreatectomy (RDP) and a right adrenal tumor resection were performed at the same time
Summary
Spleen-preserving laparoscopic distal pancreatectomy is technically challenging. Spleen-preserving laparoscopic distal pancreatectomy is currently accepted for the treatment of benign and borderline malignant pancreas tumors located distally. Preserving splenic vessels during distal pancreatectomy is an important issue. Two procedures (Kimura’s and Warshaw’s) allow spleen preservation during distal pancreatectomy [1, 2]. In the Kimura procedure, the splenic vessels are preserved, ensuring excellent blood supply to the spleen [1]. In the Warshaw procedure, the short gastric and left gastroepiploic arteries and veins are preserved, but the splenic vessels are sacrificed [2]. During traditional laparoscopic distal pancreatectomy (LDP), inherent limits and shortcomings such as limited visibility, poor ergonomics, and limited dexterity may cause a hemorrhage from vessels’ branches, and a conversion to open surgery may occur
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