Splenic Vessel Preservation Research Articles

Interim analysis of short-term outcomes after laparoscopic spleen-preserving distal pancreatectomy with or without preservation of splenic vessels: a randomised controlled trial.

Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is a widely adopted surgical approach for benign and low-grade malignant neoplasms of the distal pancreas. The Kimura and Warshaw techniques represent two principal strategies, yet it still needs to be determined which one is superior. Our investigation aimed to evaluate the clinical outcomes associated with each technique. This single-center, parallel-group, patient-blinded randomized controlled trial (RCT) was conducted at the XXXXX University. Stratified block randomization was utilized to enroll 114 patients starting in March 2022, with an interim analysis of short-term outcomes scheduled after 45%-50% of participant enrollment. Patients were randomized to receive LSPDP via either the Kimura or Warshaw technique. The primary endpoint was intraoperative blood loss, while secondary endpoints included a range of outcomes from composite outcome to quality of life, as quantified by the EQ-5D-5L. From March 2022 to November 2023, 53 patients were randomly allocated to the Kimura (n=25) or Warshaw (n=28) groups for LSPDP. Baseline characteristics and postoperative outcomes were similar between the groups, such as pancreatic fistula incidence, EQ-5D-5L index scores, and delayed gastric emptying rates. Per-protocol (PP) analysis revealed that the Kimura group experienced significantly less blood loss (52.5±51.6mL vs. 91.7±113.5mL, P=0.007) and a reduced rate of composite outcome (23.8% vs. 56.7%, P=0.019), but incurred higher costs in the Warshaw group (¥56,227.4±¥7,027.0 vs. ¥63,513.8±¥12,944.5, P=0.013). Splenic infarction rates were higher in the Warshaw group, though not statistically significant (ITT: 39.3% vs. 12.5%, P=0.058; PP: 36.7% vs. 14.3%, P=0.113), without necessitating intervention. Neither group experienced postpancreatectomy haemorrhage, 90-day mortality, or ICU admissions, and all postoperative complications were mild (Clavien-Dindo Grade <III). The 90-day interim analysis postoperatively indicates that both Kimura and Warshaw techniques for LSPDP are safe and viable. The Kimura technique, however, confers superior in terms of reduced intraoperative blood loss and fewer complications, alongside lower costs.

Minimally invasive versus open distal pancreatectomy for resectable pancreatic neuroendocrine tumors: A propensity score matched multicentric comparative French study

BackgroundMinimally invasive surgery has gained momentum for left pancreatic resections. However, debate remains about whether it has any advantage over open surgery for distal pancreatectomy for pancreatic neuroendocrine tumors. MethodsThis retrospective review examined pancreatectomies performed for resectable pancreatic neuroendocrine tumors at 21 centers in France between January 2014 and December 2018. Short and long-term outcomes were compared before and after propensity score matching based on tumor size, sex, age, body mass index, center, and method of pancreatic transection. ResultsDuring the period study, 274 patients underwent left pancreatic resection for pancreatic neuroendocrine tumors [109 underwent distal splenopancreatectomy, and 165 underwent spleen-preserving distal pancreatectomy [(splenic vessel preservation (n = 97; 58.7%)/splenic vessel resection (n = 68; 41.3%)]. Before propensity score matching, minimally invasive surgery was associated with a lower rate of major morbidity (P = .004), lower rate of postoperative delayed gastric emptying (P = .04), and higher rate of “textbook” outcomes (P = .04). After propensity score matching, there were 2 groups of 54 patients (n = 30 distal splenopancreatectomy; n = 78 spleen-preserving distal pancreatectomy). Minimally invasive surgery was associated with less blood loss (P = .05), decreased rate of major morbidity (6% vs. 24%; P = .02), less delayed gastric emptying (P = .05) despite similar rates of postoperative fistula, hemorrhage, and reoperation (P > .05). The 5-year overall survival (79% vs. 75%; P = .74) and recurrence-free survival (10% vs 17%; P = .39) were similar. ConclusionMinimally invasive surgery for left pancreatic resection can be safely proposed for patients with resectable left pancreatic neuroendocrine tumors. Minimally invasive surgery decreases the rate of major complications while providing comparable long-term oncologic outcomes.

Long-term outcomes after spleen-preserving distal pancreatectomy with splenic vessels preservation or resection: A nationwide survey of the Japanese Society of Pancreatic Surgery

BackgroundSpleen preserving distal pancreatectomy is achieved by either splenic vessel resection or splenic vessel preservation. However, the long-term outcomes of spleen-preserving distal pancreatectomy with splenic vessel resection and spleen-preserving distal pancreatectomy with splenic vessel preservation are not well known. This study aimed to evaluate the long-term outcomes of spleen-preserving distal pancreatectomy with splenic vessel resection and spleen-preserving distal pancreatectomy with splenic vessel preservation. MethodsThe study included a total of 335 patients who underwent spleen-preserving distal pancreatectomy during the study period and underwent computed tomography or magnetic resonance imaging 3 and 5 years after surgery in the Japan Society of Pancreatic Surgery member institutions. We evaluated the diameter of the perigastric and gastric submucosal veins, patency of the splenic vessels, and splenic infarction. Preoperative backgrounds and short- and long-term outcomes were compared between the 2 groups. ResultsForty-four (13.1%) and 291 (86.9%) patients underwent spleen-preserving distal pancreatectomy with splenic vessel resection and spleen-preserving distal pancreatectomy with splenic vessel preservation, respectively. There were no significant differences in short-term outcomes between the 2 groups. Regarding long-term outcomes, the prevalence of perigastric varices was higher (P = .006), and platelet count was lower (P = .037) in the spleen-preserving distal pancreatectomy with splenic vessel resection group. However, other complications, such as gastric submucosal varices, postoperative splenic infarction, gastrointestinal bleeding, reoperation, postoperative splenectomy, and other hematologic parameters, were not significantly different between the 2 groups 5 years after surgery. In terms of the patency of splenic vessels in spleen preserving distal pancreatectomy with splenic vessel preservation cases, partial or complete occlusion of the splenic artery and vein was observed 5 years after surgery in 19 (6.5%) and 55 (18.9%) patients, respectively. ConclusionPerigastric varices and thrombocytopenia were observed more in spleen-preserving distal pancreatectomy with splenic vessel resection, yet late clinical events such as gastrointestinal bleeding and splenic infarction are acceptable for spleen-preserving distal pancreatectomy with splenic vessel preservation.

Ex-situ Open Approach Spleen Preserving Splenic Hilum Lymphadenectomy.

Background: multiple studies showed important benefices arising from splenic preservation in patients with digestive cancer in general and gastric cancer in particular. The minimally invasive approach remains controversial in locally advanced gastric cancer cases whilst the open approach still has an important role. This paper's aim is to describe and present the feasibility of an open surgical technique that allows removing stations 10 together with 11p and 11d with spleen and splenic vessels preservation in pacients operated upon by open surgery. Material and Methods: We present an open "Ex-situ" spleen and pancreas preserving surgical technique that removes the anterior and posterior ganglia from the splenic hilum, the splenic vessels and the distal pancreas in locally advanced gastric cancer cases of the upper two thirds of the stomach. Forty-three consecutive patients since 2003 were operated upon by the author in multiple centers. during upper two thirds gastric cancer resections requiring no. 10 lymphadenectomy. Results: no splenectomy was needed . All the spleens were viable at postoperative Doppler echography and CT scans. No spleen migrated nor caused mechanical complications. No clinically significant pancreatic leaks were noticed. Two patients died during hospital stay, one of miocardial infarction and one of massive stroke. Pertinent follow up data and survival were not available. Conclusions: The method enables the surgeon to remove the lymph nodes no. 10 along with 11p and 11d without needing to sacrifice the spleen. All spleens were reattached sucessfully using the preserved spleno-renal ligament fold, no wandering spleen was noticed.

Inferior-Medial Approach to Laparoscopic Splenic Vessel-Preserving Distal Pancreatectomy.

Complete preservation of the splenic vessels is ideal during laparoscopic spleen-preserving distal pancreatectomy (LSPDP). However, this remains challenging and time-consuming because the vessels are often deeply embedded in the pancreatic parenchyma. Herein, we introduce our inferior-medial approach to laparoscopic splenic vessel-preserving distal pancreatectomy (lap-SVPDP) and evaluate its safety and feasibility. Forty-three patients underwent LSPDP performed by a single surgeon at our institution: 26 (60.5%) lap-SVPDPs with an inferior-medial approach and 17 with the laparoscopic Warshaw technique (lap-WT). We compared the outcomes of the 2 groups. No patient undergoing lap-SVPDP required conversion to laparotomy or lap-WT. Most preoperative characteristics and postoperative outcomes did not differ between the 2 groups; neither the operation time nor the intraoperative blood loss differed despite the greater technical complexity of lap-SVPDP. The mean tumor size was greater in the lap-WT than the lap-SVPDP group (P = .001). The splenic vein patency rate of the lap-SVPDP group was not inferior to that of the open SVPDP group treated by the same surgeon. Inferior-medial approach lap-SVPDP could be a safe and feasible technique for lap-SVPDP; neither blood loss nor operation time is increased.

Laparoscopic spleen-preserving distal pancreatectomy: A novel technique with splenic artery resection and splenic vein preservation.

Laparoscopic spleen-preserving distal pancreatectomy (LSDP) is widely performed to treat benign and low-grade malignant diseases. Although preservation of splenic vessels may be desirable considering the risk of postoperative complications, it is sometimes difficult due to tumor size, inflammation, and proximity of the tumor and splenic vessels. Herein, we present the first case of LSDP with splenic artery resection and splenic vein preservation. A 40-year-old woman with a pancreatic tumor was referred to our hospital. Contrast-enhanced computed tomography (CT) revealed a tumor in the pancreatic tail that was in contact with the splenic artery and distant from the splenic vein. The splenic artery and vein were separated from the pancreas near the dissection line. The splenic artery was resected after pancreatic dissection using a linear stapler. After the pancreatic tail was separated from the splenic hilum while preserving the splenic vein, the distal side of the splenic artery was resected, and the specimen was removed. The postoperative course was uneventful and the patient was discharged on postoperative Day 9. Four months after surgery, postoperative follow-up CT findings showed neither splenic infarction nor gastric varices. This technique is an alternative method of splenic preservation when there is no attachment of the tumor to the splenic vein or uncontrolled expected bleeding of the splenic artery using the Kimura technique.

Spleen-preserving pancreatectomy with removal of splenic vessels: impact on splenic parenchyma ?

BackgroundWhile outcomes after spleen-preserving distal pancreatectomy (SP-DP) have been widely reported, impacts on splenic parenchyma have not been well studied. This study aimed to compare postoperative outcomes, particularly spleen-related outcomes, by assessing splenic imaging after SP-DP with or without splenic vessels removal.MethodsData for all patients who underwent SP-DP with splenic vessels removal (Warshaw technique, WDP) or preservation (Kimura technique, KDP) between 2010 and 2022 in two tertiary centres were retrospectively analysed. Splenic ischemia and volume at early/late imaging and postoperative outcomes were reviewed.ResultsEighty-seven patients were included, 51 in the WDP and 36 in the KDP groups. Median Charlson’s Comorbidity Index was significantly higher in the WDP group compared with the KDP group. Postoperative morbidity was similar between groups. There was more splenic ischemia at early imaging in the WDP group compared to the KDP group (55% vs. 14%, p = 0.018), especially severe ischemia (23% vs. 0%). Partial splenic atrophy was observed in 29% and 0% in the WDP and KDP groups, respectively (p = 0.002); no complete splenic atrophy was observed. Platelet levels at POD 1, 2 and 6 were significantly higher in the WDP group compared to KDP group. At univariate analysis, age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction were prognostic factors for development of splenic atrophy. No episodes of overwhelming post-splenectomy infection or secondary splenectomy were recorded after a median follow-up of 9 and 11 months in the WDP and KDP groups, respectively.ConclusionsSplenic ischemia appeared in one-half of patients undergoing SP-DP with splenic vessels removal at early imaging, and partial splenic atrophy in almost 30% at late imaging, without clinical impact or complete splenic atrophy. Age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction could help to predict the occurrence of splenic atrophy.

“Parenchyma transection-first” strategy is superior to “tunnel-first” strategy in robotic spleen-preserving distal pancreatectomy with conservation of splenic vessels

BackgroundCreating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection (“tunnel-first” strategy) has long been used in spleen-preserving distal pancreatectomy (SPDP) with splenic vessel preservation (Kimura's procedure). However, the operation space is limited in the tunnel, leading to the risks of bleeding and difficulties in suturing. We adopted the pancreatic “parenchyma transection-first” strategy to optimize Kimura's procedure. MethodsThe clinical data of consecutive patients who underwent robotic SPDP with Kimura's procedure between January 2017 and September 2022 at our center were retrieved. The cohort was classified into a “parenchyma transection-first” strategy (P-F) group and a “tunnel-first” strategy (T-F) group and analyzed. ResultsA total of 91 patients were enrolled in this cohort, with 49 in the T-F group and 42 in the P-F group. Compared with the T-F group, the P-F group had significantly shorter operative time (146.1 ± 39.2 min vs. 174.9 ± 46.6 min, P < 0.01) and lower estimated blood loss [40.0 (20.0–55.0) mL vs. 50.0 (20.0–100.0) mL, P = 0.03]. Failure of splenic vessel preservation occurred in 10.2% patients in the T-F group and 2.4% in the P-F group (P = 0.14). The grade 3/4 complications were similar between the two groups (P = 0.57). No differences in postoperative pancreatic fistula, abdominal infection or hemorrhage were observed between the two groups. ConclusionsThe pancreatic “parenchyma transection-first” strategy is safe and feasible compared with traditional “tunnel-first strategy” in SPDP with Kimura's procedure.

The clinical difference and CT finding of fluid collection after laparoscopic distal pancreatectomy according to spleen and splenic vessel preservation

The clinical difference and CT finding of fluid collection after laparoscopic distal pancreatectomy according to spleen and splenic vessel preservation

Preliminary experience with a new robotic technique to facilitate distal pancreatectomy with spleen preservation: left lateral approach in right lateral decubitus position.

Spleen-preserving distal pancreatectomy (SP-DP), for patients with benign or small low-grade malignant tumors of the body or tail of the pancreas, is the ideal procedure although it is technically demanding. The robotic da Vinci system has been introduced to overcome these technical challenges and reduce operative risks. We report our experience of a new variation in surgical technique: the left lateral approach robotic spleen-preserving distal pancreatectomy (RSP-DP) in right lateral decubitus position. We performed this new variant of SP-DP, in five patients, using the da Vinci Xi system. Technical and clinical feasibility are described. The mean age and body mass index were 53.4years and 31.4kg/m2, respectively. The mean total operative time was 323min. The estimated mean blood loss was 240ml. In all patients, the spleen could be preserved. In four patients, the splenic vessels were also preserved. One patient required a Warshaw technique due to significant fibrosis attached to the splenic vein. The postoperative period of all patients was uneventful except the presence of biochemical leak (BL) in two patients that only required maintenance of the drainage at home. The mean length of hospital stay was 6days after surgery. The left lateral approach robotic SP-DP in right lateral decubitus position is a feasible and safe procedure for distal benign or small low-grade malignant tumors of the left pancreas. The right lateral decubitus position associated to robotic surgery can facilitate this complex procedure, especially when splenic vessels preservation is indicated, with a lower risk of conversion and shortening of the learning curve.

Spleen-preserving total pancreatectomy for low-grade tumors

To justify organ-preserving variants of total pancreatectomy. We retrospectively analyzed the results of classic and modified total pancreatectomy between September 2010 and March 2021. Implementing pylorus-sparing total pancreatectomy with preservation of stomach, spleen, gastric and splenic vessels, we thoroughly analyzed exocrine/endocrine disorders after total pancreatectomy and changes in immune status after splenectomy. Serum C-reactive protein and ferritin were assessed in 1, 3, 5, 7, 14 and 30 days after surgery in both groups. We also estimated daily glycemic profile after total pancreatectomy in classical and organ-preserving modifications. We performed 37 total pancreatectomies including 12 pylorus-preserving total pancreatectomies with preservation of stomach, spleen, gastric and splenic vessels. General and specific postoperative complication rate was significantly lower after modified surgery compared to classic total pancreatectomy with gastric resection and splenectomy. Modified total pancreatectomy is preferable for low-grade pancreatic tumors.

A New Robotic Technique to Facilitate Distal Pancreatectomy with Preservation of Splenic Vessels: Left Lateral Approach in Right Lateral Decubitus Position

A New Robotic Technique to Facilitate Distal Pancreatectomy with Preservation of Splenic Vessels: Left Lateral Approach in Right Lateral Decubitus Position

Robotic Spleen-Preserving Distal Pancreatectomy with Preservation of Splenic Vessels Using the Gastrohepatic Ligament Approach: The Superior Window Approach in the Kimura Technique

Minimally invasive spleen-preserving distal pancreatectomy (SPDP) is technically challenging, and only a few reports have described surgical approaches for minimally invasive SPDP. This report demonstrates our novel gastrohepatic ligament approach in robotic SPDP with preservation of the splenic vessels (the superior window approach in the Kimura technique). Our gastrohepatic ligament approach for robotic SPDP included four steps. First, the gastrohepatic ligament was divided extensively, and the pancreas was confirmed (step 1). In this step, we did not lift the stomach, nor did we divide the gastrocolic ligament. Next, the superior and inferior borders of the pancreas were dissected, and the tunneling of the pancreas on the superior mesenteric vein was performed (step 2). Following the division of the pancreas (step 3), the pancreatic body and tail were dissected from the medial to the lateral side with preservation of the splenic vessels (step 4). Using this approach, the pancreas can be directly accessed via the gastrohepatic ligament route and dissected without division of the gastrocolic ligament or retraction of the stomach. The present approach for robotic SPDP preserves splenic vessels, facilitating easy access to the pancreas with minimal dissection, and may be optional in selected patients, including those with low body mass index.

Comparison of splenic vessel preserving distal pancreatectomy and the Warshaw technique for solid pseudopapillary neoplasm in children.

Spleen-preserving distal pancreatectomy (SPDP) such as splenic vessel preservation (SVP) for solid pseudopapillary neoplasms (SPNs) in the body or tail of the pancreas in children prevents post-splenectomy infection and hematologic disorders. However, SVP could be technically challenging, and the Warshaw technique (WT) could be an alternative technique that has been reported to be safe and effective in adults. We, therefore, compared the perioperative outcomes of SVP and WT in pediatric patients. We retrospectively reviewed the medical records of pediatric patients with SPN who underwent SPDP using SVP or WT between November 2002 and November 2018 at a large-sized tertiary referral center. Twenty-eight patients were included. Sixteen (57.1%) patients underwent SVP and 12 (42.9%) patients underwent WT. There were no significant differences in the baseline characteristics between the two groups. Postoperative complications occurred in 8 patients each in the SVP (50%), and the WT (66.7%) groups. Two (12.5%) in the SVP group and 1 (8.3%) in the WT group required additional intervention. During a median follow-up duration of 49months, there were no significant differences in the incidence of splenic infarctions or perigastric varices between the two groups. There were no significant differences in the surgical outcomes between WT and SVP in pediatric patients with SPN. WT could be a safe and feasible alternative technique for SVP in challenging cases.

A New Robotic Technique to Facilitate Distal Pancreatectomy with Preservation of Splenic Vessels: Left Lateral Approach in Right Lateral Decubitus Position

Introduction: Spleen-preserving distal pancreatectomy (SPDP), with or without splenic vessel preservation, is the technique of choice for patients with benign or small low-grade malignant tumours of the body or tail of the pancreas, as it avoids the potential side effects of splenectomy. Furthermore, splenic vessel-preserving distal pancreatectomy (SVPDP) is the ideal procedure although it is technically demanding, even when performed by open surgery. In order to simplify the preservation of the splenic vessels, different open and laparoscopic approaches have been described in the literature. Methods: In this article, we describe a new variation in surgical technique performed at our centre: robotic left-lateral approach SVPDP in right lateral decubitus position, in a patient with a solid and pseudopapillary neoplasm (SPN) of the pancreatic tail. Results: Recent publications have shown a higher splenic preservation rate in robotic distal pancreatectomy when compared to the laparoscopic approach. Our experience shows that the robotic approach might facilitate this procedure and shorten hospital stay. Conclusions: The robotic left lateral approach-SVPDP in the right lateral decubitus position is a feasible and safe approach for distal benign or small low-grade malignant tumours of the pancreatic tail. The right lateral decubitus position associated with robotic assistance can facilitate this complex procedure with a lower risk of conversion and shorten the learning curve.

Short-Term Outcomes of the Tail-First Approach in Laparoscopic Spleen-Preserving Distal Pancreatectomy: a Single Center Experience

BackgroundSeveral approaches have been reported during laparoscopic spleen-preserving distal pancreatectomy (LSPDP), such as medial, lateral, and posterior approaches. This study reports a tail-first approach that is mobilization of the pancreatic gland from tail to neck followed by division. The short-term outcomes are described. MethodsCases which underwent LSPDP from 2014 to 2020 at Qilu Hospital of Shandong University were included. Clinical parameters were collected and analyzed. ResultsOne hundred five cases were collected, including 54 Kimura, 45 Warshaw, and 6 modified-Warshaw procedures. Seventy-seven patients (73.3%) underwent LSPDP by a tail-first approach (TFA-LSPDP) and 28 (26.7%) by a medial approach (M-LSPDP). Compared with the M-LSPDP, the TFA-LSPDP group had a lower incidence of splenic infraction (9.1 VS 25.0%, P = 0.05) and a higher frequency of Kimura procedure (55.8 VS 39.3%, P = 0.053). ConclusionTFA-LSPDP is feasible and safe for treatment of benign and low malignant lesions of the distal pancreas, which has a lower incidence of splenic infraction and a higher frequency of splenic vessel preservation compared with the traditional medial approach.

Preoperative body mass index and amylase level predict postoperative pancreatic fistula independently

Postoperative pancreatic fistula (POPF) is one of the difficult complications after distal pancreatectomy (DP), resulting increased postoperative morbidity and mortality. It is still a hotspot to prevent the occurrence of POPF in recent researches. Our study aimed to investigate the risk factors of pancreatic fistula in patients following DP. We retrospectively analyzed 206 patients with DP in Tongji Hospital, China, from January 2014 to March 2019. Univariate and multivariate logistic regressions were performed to assess the risk factors of POPF. A total of 206 eligible patients were enrolled into this study, including 123 females and 83 males. The overall morbidity was 30.1%. Postoperative complications included postoperative biliary fistula (0.5%), delayed gastric emptying (1%), grade B pancreatic fistula (4.9%), grade C pancreatic fistula (1.9%), postoperative abdominal abscess (2.4%), wound infection (3.4%), percutaneous drainage (18.4%) and reoperation (0.5%). The first hospitalization time was 24 days. There were 21 patients re-hospitalized within 30 days and 8 patients within 90 days. No postoperative death was observed.Univariate analysis indicated that the occurrence of POPF was related to preoperative BMI > 25 kg/m2 (p = 0.034), serum pancreatic amylase > 53 U/L (p = 0.049), splenic preservation (p = 0.069) and splenic vessel preservation (p = 0.036). Multivariate analysis showed that preoperative BMI > 25 kg/m2 (OR = 2.637, p < 0.05) and serum pancreatic amylase > 53 U/L (OR = 2.658, p < 0.05) were independent risk factors of clinical related-postoperative pancreatic fistula. Preoperative BMI > 25 kg/m2 and serum amylase > 53 U/L are independent risk factors of POPF. It is necessary to monitor BMI and amylase level preoperatively in patients undergoing DP.

Robotic versus open total pancreatectomy: a retrospective cohort study.

Robotic total pancreatectomy (RTP), although considered safe and feasible, has rarely been reported. This study aimed to evaluate whether RTP has advantages over open TP (OTP). Demographics and perioperative outcomes among patients who underwent RTP (n=14) versus OTP (n=15) between May 2015 and September 2020 were retrospectively analyzed. RTP reduced the operative time (307.2 vs. 382.0 min, p=0.01) and estimated blood loss (EBL) (200 vs. 700 ml, p=0.002) compared to those of OTP. The patients in the RTP group got out of their beds and stood, received their first liquid, and took oral diets earlier (2.0 vs. 3.0 days, p=0.002; 2.0 vs. 4.0 days, p=0.009; 3.0 vs. 5.0 days, p=0.006) and experienced a shorter postoperative hospital stay (PHS) (9.0 vs. 12.0 days, p=0.03). There were no significant differences in the rates of spleen preservation, splenic vessel preservation, bile leakage, delayed gastric emptying, morbidity, or the number of lymph nodes harvest between the two groups. This study demonstrates that RTP is safe and feasible in selected patients with different indications in experienced robotic center. RTP was associated with a shorter operative time, lower EBL, and shorter PHS than OTP.

The Robotic Spleen Preserving Distal Pancreatectomy Under Temporary Splenic Artery Occlusion: the Royal North Shore Technique

There are numerous advantages of splenic vessel preservation in performing the minimally invasive spleen preserving distal pancreatectomy. Dissection along the splenic artery, and a medial to lateral dissection of the splenic vein, is associated with high risk of injury and bleeding. Proximal control of the splenic artery with vessel loops, which require tightening or adjustment with the advent of distal bleeding, is inefficient. Instead, a modified technique (the Royal North Shore Technique), whereby a vascular clamp is placed on the splenic artery, reduces splenic artery inflow and indirectly, splenic vein returns. This allows for more accurate and injury-free dissection of the now non-distended splenic vein and the associated tributaries, and maintains a relatively bloodless field in the event of arterial injury.

A retrospective comparative study of robotic distal pancreatectomy with or without splenic vessel and spleen preservation

BackgroundRobotic distal pancreatectomy has been accepted to be safe and effective for pancreatic tail lesion. Whether spleen preservation by preserving the splenic vessels with robot assistance is feasible and beneficial remains controversial. Here we would like to compare the operative outcomes of robotic distal pancreatectomy and splenectomy (DPS) with robotic spleen preserving distal pancreatectomy by means of splenic vessel preservation (SVP). MethodsBetween March 2011 and September 2019, 56 consecutive patients undergoing robotic distal pancreatectomy were identified, with 28 patients in each group. Patient demographics, histopathology findings and operative outcomes were prospectively collected and compared between the two groups. A subgroup analysis was made after excluding malignant and pancreatic lesions >6 cm in the DPS group. ResultsThe two groups had similar conversion rate, blood loss, morbidity and pancreatic fistula rate. There was no operative mortality. The SVP group had shorter median operative time (245 vs 303.5 min, P = 0.019) and shorter median hospital stay (5 vs 6 days, P = 0.019) than the DPS group. However, all malignant lesions occurred in the DPS group and lesion size in DPS group was significantly larger. After matching, there were 28 SVP and 15 DPS. The histopathology findings and lesion size became comparable. The SVP group still had shorter operative time (245 vs 290 min, P = 0.022) and shorter hospital stay (5 vs 7 days, P = 0.014) than the DPS group. ConclusionApart from avoiding risk of overwhelming postsplenectomy sepsis, robotic SVP had additional advantage of shorter operative time and shorter hospital stay than robotic DPS.