Splenic artery as a simple landmark indicating difficulty during laparoscopic distal pancreatectomy.

Abstract

The use of laparoscopic distal pancreatectomy (LDP) is increasing worldwide. It is important for surgeons to predict preoperatively the difficulty and risks of a surgery. However, very few reports have evaluated the impact of patient or tumor factors on the difficulty of LDP. We aimed to determine the predictors of technical difficulties when performing LDP. This study included 34 patients who underwent LDP. Patient information was obtained retrospectively and included age, gender, BMI, primary disease, previous abdominal surgery, previous pancreatitis, tumor size, tumor proximity to the splenic arterial origin, type of splenic artery (SpA), operative time, blood loss, postoperative pancreatic fistula, and length of hospital stay. Univariate and multivariate analyses were performed to determine the predictors of a long operative time. SpA anatomy was classified into two types based on the relationship between its origin and the pancreas. Patients whose SpA origin was upward of the pancreatic parenchyma were classified as SpA type 1, whereas patients whose SpA origin was covered by the pancreatic parenchyma were classified as SpA type 2. Multivariate analysis revealed SpA type 2 to be an independent risk factor for a long operation (odds ratio = 9.925; 95% confidence interval: 1.461-67.412; P = 0.019). SpA type 2 was related to a longer operative time (P < 0.001) and greater intraoperative blood loss (P = 0.001). Classification according to SpA type is simple and useful for predicting technical difficulty when performing LDP.