Splenic vessels first approach laparoscopic spleen-preserving distal pancreatectomy with kimura technique (with short video clip)

Abstract

Aim: In order to improve the success rate of spleen preservation in laparoscopic distal pancreatectomy with Kimura technique, we use a new splenic vessels control procedure which we call splenic vessels first approach. Method: We begin the operation with dividing the gastrosplenic ligament in order to expose the body and tail of the pancreas. We are now dissecting out the splenic artery first. With opening the capsule of the superior border of the pancreas, here the splenic artery comes into view. The proximal splenic artery is blocked with a bulldog. The next step wiil be distal splenic vein mobilization and blockage. We dissect at left side of the inferior border of the pancreas tail near the splenic hilus and block the distal splenic vein with another bulldog. After fully blocking the proximal splenic artery and distal splenic vein, we perform laparoscopic spleen-preserving distal pancreatectomy with standard Kimura technique. Result: With fully controlling the inflow of splenic artery and outflow of distal splenic vein , the distal pancrease is easy dissected with the splenic vessels presevation. We have successfully fulfilled all 10 cases of laparoscopic spleen-preserving distal pancreatectomy with Kimura technique. No postoperative splenic complications such as splenic infarction and abscess have been founded by far. Conclusions: Splenic vessels first approach laparoscopic spleen-preserving distal pancreatectomy is a safe procedure and offers technique advantages of lesser blood loss, operation time spare and higher success rate of spleen preservation over the conventional Kimura technique, while no extra postoperative morbidity founded.