Resection Of Splenic Vessels Research Articles

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.

Recovery of Splenic Volume and Function after Distal Pancreatectomy with Resection of Splenic Vessels and Preservation of the Spleen (Warshaw Technique)

Recovery of Splenic Volume and Function after Distal Pancreatectomy with Resection of Splenic Vessels and Preservation of the Spleen (Warshaw Technique)

Laparoscopic spleen-preserving distal pancreatectomy with splenic vessels resection (laparoscopic Warshaw procedure).

Laparoscopic spleen-preserving distal pancreatectomy with splenic vessels resection (laparoscopic Warshaw procedure).

Resection of the splenic vessels during laparoscopic central pancreatectomy is safe and does not compromise preservation of the distal pancreas

BackgroundThe diagnosis of low potential malignant diseases is increasingly frequent, and laparoscopic central pancreatectomy can be indicated in these patients. Laparoscopic central pancreatectomy that usually preserves the splenic vessels results in a low risk of new-onset diabetes but high morbidity, mainly due to postoperative pancreatic fistula and postpancreatectomy hemorrhage. In this study, we evaluated the short and long-term complications after laparoscopic central pancreatectomy with splenic vessel resection. MethodsThis retrospective single-center cohort study included 650 laparoscopic pancreatic resections from 2008 to 2020 with 84 laparoscopic central pancreatectomy; 15 laparoscopic central pancreatectomy with splenic vessel resection; and 69 laparoscopic central pancreatectomy with preservation of the splenic vessels. Pancreaticogastrostomy was routinely performed, and the patients were discharged after complications had been treated. The 15 laparoscopic central pancreatectomy with splenic vessel resection were matched for age, sex, body mass index, and tumor characteristics [1:2] and compared with 30 laparoscopic central pancreatectomy with the preservation of the splenic vessels. ResultsIn the laparoscopic central pancreatectomy with splenic vessel resection group, resection of splenic vessels was performed due to tumoral or inflammatory adhesions (n = 11) or accidental vascular injury (n = 4). The demographic characteristics of the groups were similar. Tumors were larger in the laparoscopic central pancreatectomy with splenic vessel resection group (40 vs 21 mm; P = .008), and right transection on the body of the pancreas (53% vs 13%; P = .01) was more frequent. There were no differences in the characteristics of the pancreas (Wirsung duct size or consistency). The median operative time (minutes) was longer in the laparoscopic central pancreatectomy with splenic vessel resection group than in the laparoscopic central pancreatectomy with preservation of the splenic vessels group (210 vs 180, respectively; P = .15) with more blood loss (100 mL vs 50 mL, respectively; P = .012). The lengths (mm) of the resected pancreas and remnant distal pancreas in the 2 groups were 65 vs 50 (P = .053) and 40 vs 65 (P = .006), respectively. There were no differences in postoperative mortality (0% vs 3%; P = .47), grade B–C postoperative pancreatic fistula (27% vs 27%; P = 1), reintervention (7% vs 13%; P = .50), grade B–C postpancreatectomy hemorrhage (0% vs 13%; P = .13), length of hospital stay (20 days vs 22 days; P = .15), or new-onset diabetes (7% vs 10%; P = .67) between the 2 groups. ConclusionLaparoscopic central pancreatectomy with splenic vessel resection is a safe technical modification of central pancreatectomy that does not prevent preservation of the distal pancreas and does not influence postoperative pancreatic fistula or endocrine insufficiency. Furthermore, it could reduce the risk of postpancreatectomy hemorrhage.

Resection of the Splenic Vessels during Laparoscopic Central Pancreatectomy Is Safe and Does Not Compromise Preservation of the Distal Pancreas

Introduction: Laparoscopic central pancreatectomy (LCP) for non-malignant tumours, usually preserving splenic vessels (LCP-PreSV), allows a low-risk of new onset diabetes and high morbidity represented mainly by postoperative pancreatic fistula (POPF) and post-pancreatectomy haemorrhage (PPH). In this study, we evaluated the impact of the splenic vessels resection (LCP-ResSV) on short and long-term complications. Methods: This was a retrospective single center cohort study. Of 650 laparoscopic pancreatic resections from 2008 to 2020, 84 LCP with pancreatogastric anastomosis were performed. The 15 LCP-ResSV were matched [1:2] and compared with 30 LCP-PreSV according to age, sex, BMI and tumour characteristics. Results: In the LCP-ResSV, splenic vessels resection was performed related to tumoral or inflammatory adhesions (n=11) and accidental vascular injury (n = 4). In the LCP-ResSV group, the tumour size was larger (40 vs 21 mm;p=0.008) and the right transection more frequently performed on the body (53%vs13%; p=0.01). The median operative time (min) was longer (210vs180; p=0.15) with more blood loss (100 mLvs 50 mL; p=0.012), respectively. The lengths (mm) of the resected pancreas and remnant distal pancreas were 65 vs 50 (p=0.053) and 40 vs 65 (p=0.006), respectively. There were no significant differences regarding postoperative mortality (0%vs3%), grade B-C POPF (27%vs27%), re-intervention (7%vs13%), grade B-C PPH (0%vs13%), hospital stay (20vs22 days) and new onset diabetes (7%vs10%). Conclusion: LCP-ResSV is a safe technical modification of CP that does not compromise preservation of the distal pancreas with no impact on POPF or endocrine insufficiency, compared to LCP-PresSV. Furthermore, it could reduce the risk of PPH.

Resection of the Splenic Vessels during Laparoscopic Central Pancreatectomy is Safe and Does Not Compromise Preservation of the Distal Pancreatectomy

Objective: Low potential malignant diseases are more frequently discovered and laparoscopic central pancreatectomy (LCP) can be indicated. LCP usually preserving splenic vessels (LCP-PreSV), allows a low-risk of diabetes at the expense of a high morbidity represented mainly by postoperative pancreatic fistula (POPF) and haemorrhage (PPH). We evaluated the impact of the splenic vessels resection (LCP-ResSV) on short and long-term complications.

Laparoscopic total pancreatectomy with splenic vessels resection for pancreatic metastasis from renal cell carcinoma.

Laparoscopic total pancreatectomy with splenic vessels resection for pancreatic metastasis from renal cell carcinoma.

Why is important to know how spleen survives after spleen-preserving distal pancreatectomy with splenic vessels resection? experience of 51 operations without splenectomies

Background: Knowledge of spleen collaterals is important as for distal spleen-preserving pancreatectomy with splenic vessels resection (DSPPSVR), so as for possible upper GI surgery for these patients.

Resection of the splenic vessels during laparoscopic central pancreatectomy is safe and reduces the risk of post-operative haemorrhage

Purpose: Low potential malignant diseases are more frequently discovered and laparoscopic central pancreatectomy (LCP) can be indicated. LCP usually preserving splenic vessels (LCP-PreSV), allows a low-risk of new onset diabetes at the expense of a high morbidity represented mainly by post-operative pancreatic fistula (POPF) and bleeding. In this study, we evaluated the impact of the splenic vessels resection (LCP-ResSV) on short and long term complications. Methods: Of 650 laparoscopic pancreatic resections from 2011 to 2020, 84 LCP were performed, including 15 LCP-ResSV and 69 LCP-PreSV. The 15 CPL-ResSV were matched [1:2] with 30 CPL-PreSV according to age, sex, BMI and tumor characteristics (neuroendocrine tumor, mucinous cystadenoma, intraductal papillary mucinous neoplasm, solid pseudopapillary neoplasm, cyst, others). Pancreatogastric anastomosis was achieved in all patients and patients were discharged after healing of complications. Both groups (LCP-ResSV vs LCP-PreSV) were compared. Results: In the LCP-ResSV, splenic vessels resection were performed related to tumoral or inflammatory adhesions (n=11) and accidental vascular injury (n = 4). There was no difference regarding demographics data. The tumour size was larger in LCP-ResSV (40mm vs 21mm; p = 0.008) and the right transection was more frequently done on the body (53% vs 13%; p=0.01). There was no difference in pancreatic characteristics (Wirsung duct size and consistency). The median operative time was longer in LCP-ResSV group (210 min vs 180 min ; p=0.15) with more blood loss (100 mL vs 50 mL ; p=0.012). The lengths (mm) of the resected pancreas and remnant distal pancreas were 65mm vs 50mm (p=0.053) and 40mm vs 65mm (p=0.006), respectively. There were no differences regarding post-operative mortality (0% vs 3% ; p = 0.47), grade B-C POPF (27% vs 27% ; p = 1), re-intervention (7% vs 13% ; p = 0.50); grade B-C bleeding (0% vs 13%; p = 0.13), length of hospital stay (20 days vs 22 days; p = 0.15) and new onset diabetes (7% vs 10%; p = 0.67). Conclusion: LCP-ResSV is a safe technical modification of central pancreatectomy with no impact on pancreatic fistula risk or endocrine insufficiency, compared to LCP-PreSV. Furthermore, it could reduce the risk of post-operative haemorrhage.

Laparoscopic distal pancreatectomy for benign and malignant disease: a review of techniques and results.

Diagnosis of pancreatic cancer is challenging in the initial phases because its progression is rapid. The pancreatic tail and body roughly accounts for 20–30% of all cancerous cases. The standard treatment for symptomatic benign, malignant, and premalignant diseases of the pancreatic tail and body is distal pancreatectomy. This technique has been modified over the years to fit certain indications, with the goal of enhancing post-operative results as well as reducing patient trauma. In cases of a premalignant and symptomatic benign condition, the spleen must be preserved either using Kimura’s splenic vessel preservation technique or Warshaw’s splenic vessel resection technique. A better long-term prognosis is ensured by regional lymph node dissection and radical R0 resection. Radical antegrade modular pancreatosplenectomy was proposed to tackle the shortcomings of traditional surgery for pancreatic tail and body cancer. In this review, study techniques and results of laparoscopic distal pancreatectomy for malignant and benign pancreatic ailments were described with the intention of providing knowledge on various suitable techniques reported for pancreatic cancer treatment. Furthermore, this study will serve as a ready reckoner for surgeons and could serve to boost their confidence levels during surgery by avoiding confusion on the selection of suitable for the pancreatic diseases diagnosed.

Warshaw Technique in Laparoscopic Spleen-Preserving Distal Pancreatectomy: Surgical Strategy and Late Outcomes of Splenic Preservation.

Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) can be accomplished with either the preservation or the resection of splenic vessels; the latter is also known as Warshaw technique. Our study is designed to investigate the operation selection strategy when proceeding LSPDP and to evaluate the long-term outcomes of patients undergoing Warshaw surgery. The medical records and follow-up data of patients who underwent LSPDP in Qilu Hospital, Shandong University, were reviewed retrospectively. A total of thirty-five patients were involved in this study, including 17 cases of patients who were treated with Warshaw procedure (WT) while the other 18 cases had splenic vessels preserved (SVP). Compared with the SVP group, the operative time and intraoperative blood loss in WT group were improved significantly. The incidence of early postoperative splenic infarction was higher in WT group. However, there was no report of splenic abscess or second operation. Follow-up data confirmed that there was no significant difference in spleen phagocytosis and immune function compared with normal healthy population. Our study confirms that LSPDP-Warshaw procedure is a safe and efficient treatment for the benign or low grade malignant tumors in distal pancreas in selected patients. The long-term spleen function is normal after Warshaw procedure. Preoperative assessment and intraoperative exploration are recommended for the selection of operation approaches.

Forty-five spleen-preserving distal pancreatectomy with splenic vessels resection without splenectomies. Which arteries can we rely on?

The Warshaw (WT) and the Kimura (KT) techniques are both used for open or minimally invasive (MI) spleen preserving distal pancreatectomy (SPDP). Multicenter studies on long-term outcome of WT and KT are lacking.Multicenter retrospective study with transversal follow-up moment, including patients who underwent SPDP from 2000 to 2017 at three high-volume centers in Italy and the Netherlands. Primary endpoint was the incidence of short and long term complications. Patients without regular follow-up were interviewed about symptoms and complications.In total, 164 patients were enrolled, 55 WT (33.5%) and 109 kT (66.5%), of which 95 (57.9%) MI. There was no 30-day mortality (0%).The only significant difference in short-term outcome was more delayed gastric emptying (DGE) after WT (9.1% vs 1.8%, p = 0.043). MI-SPDP was associated with less blood loss (median 150 vs 250 ml, respectively, p < 0.001), less DGE (0% vs 10%, p = 0.002), less abdominal abscesses (8.4% vs 18.4%, p = 0.03) and less splenic infarctions (3.2% vs. 13%, p = 0.042), than open SPDP. Long-term follow-up (median 41 months) was available for 111 patients (67.7%) of whom 18 (16.2%) had an SPDP-related long-term sequela, mostly perigastric varices (n = 11, 9%) but without differences between WT and KT. Less long-term sequelae were reported after MI as compared to open SPDP (12.5% vs 21.2%, p = 0.032).In this international retrospective study, the WT and KT had comparable short- and long-term outcomes. If a KT does not seem feasible during SPDP, a WT is recommended, rather than performing a splenectomy. MI-SPDP was associated with less short- and long term complications as compared to an open SPDP.

Laparoscopic central pancreatectomy under clampage of the portomesenteric vein and resection of splenic vessels for large solid and cystic pseudopapillary tumor

Summary Background: Solid and cystic pseudopapillary tumor (SCPP) is frequently encountered in young females and pancreatectomy without tumor rupture is the standard of treatment. The laparoscopic approach is very indicated as patients are young and the risk of lymph nodes invasion or true vascular invasion is slow. Patients and methods: We present the case of a 24 year old female patient in whom a large SCPP was discovered on abdominal pain. The tumor of 6 cm was located on the neck-body junction with close contact with the anterior aspect of the mesentericoportal vein (MPV) and the splenic vessels. To avoid pancreatoduodenectomy or distal pancreatectomy, we decided to do laparoscopic central pancreatectomy with resection of the splenic vessels and reconstruction of the MPV if needed. She underwent central pancreatectomy with resection of the splenic vessels and the MPV was liberated from the tumor under clampage for 10 minutes without the need for reconstruction. Results: The operative duration was 260 minutes with 200 ml of blood loss. The postoperative course was uneventful with 16 days of hospital stay. Histology confirmed the diagnosis of SCPP tumor of 6 cm, R0 and N0. One year after, the patient is completely asymptomatic with no tumor recurrence and no pancreatic insufficiency. Conclusion: SCPP tumor is a good indication to the laparoscopic approach because encountered in young patients with low risk of lymph nodes or true vascular invasion. Even for large tumors, limited pancreatic resection like central pancreatectomy is possible to avoid large pancreatectomy in these young patients.

Simplicity and Safety: Minimized Pancreatic Fistula Rate after Distal Pancreatectomy through Pancreas Stump Sutured Fish-Mouth Closure

Pancreatic stump leak after distal pancreatectomy (DP) is a major determinant for impaired postoperative recovery. Factors influencing pancreatic fistula (PF) occurrence remain of interest. Prospectively collected data from an academic surgical oncology practice were examined for predictors of PF. Seventy-five of 294 pancreatectomy patients underwent DP (26%). There were 33 men and 42 women, with a median age of 61 years (range: 18-85 years). Underlying conditions included cancer (60%) and benign processes (40%). Resections were comprising open DP (64%), laparoscopic DP (21%), and open multivisceral resections (15%). Of 21 cases with postoperative complications (28%, no death), six were PFs (8%, 2 grade A and 4 grade B). The median length of stay was six days (4-24). The PF rate was 2.0 per cent in 50 patients after sutured fish-mouth closures, but 20 per cent in cases using other techniques including stapling (P = 0.007); no other variable was linked to PF occurrence. Length of stay was linked to complications, resection extent, malignancy, and transfusions (all at P < 0.02), but not to PF. PF rate after DP in this experience is unaffected by splenic vessel resection but seems to be minimized through a sutured fish-mouth closure technique.

Clinical efficacy of spleen-preserving distal pancreatectomy with or without splenic vessel preservation

Objective:The meta-analysis was performed to investigate the clinical efficacy of spleen-preserving distal pancreatectomy with splenic vessel preservation (SPDP-SVP) and spleen-preserving distal pancreatectomy with splenic vessel resection (SPDP-SVR).Methods:Potential articles were searched on the databases of Pubmed, Embase, and Chinese National Knowledge Infrastructure (CNKI) from January 1988 until March 2017. Weight mean difference (WMD) with 95% confidence interval (CI) was applied to compare the efficacy of SPDP-SVP and SPDP-SVR. Odds ratio (OR) with 95% CI was calculated to figure out the risks for complications. P< .05 or I2>50% indicated significant heterogeneity. The random-effects model is used to pool data if significant heterogeneity exists; otherwise, the fixed-effects model is used. Publication bias was evaluated by Begg's funnel plot.Results:Thirteen eligible articles were obtained in the meta-analysis. SPDP-SVP seemed to relate with reduced operative time and blood loss, prolonged hospital stay, and less complications; however, the effects were not statistically significant. Meanwhile, we found that SPDP-SVP was closely related with the reduced rate of splenic infarction and gastric varices (OR = 0.16, 95% CI = 0.09–0.29; OR = 0.08, 95% CI = 0.02–0.35). No publication bias was observed in the analysis (P = .636).Conclusions:SPDP-SVP seems to show superiority than SPDP-SVR in reducing the rate of splenic infarction and gastric varices.

Clinical study on splenic infarction after spleen-preserving distal pancreatectomy

Objective To compare splenic infarction incidence and clinical outcome of spleen-preserving distal pancreatectomy (SPDP) with splenic vessel preservation (SVP, Kimura procedure) or splenic vessel resection (SVR, Warshaw procedure). Methods We retrospectively reviewed clinical data of 181 patients who underwent SPDP for benign and low-grade malignant tumors occurred in pancreatic body and cauda between January 2007 and December 2013. Cases were divided into SVP (n=146) and SVR (n=35) groups. Safety and postoperative complications were compared to evaluate splenic infarction between the two groups. Results There were no significant differences in operation duration, intraoperative blood loss between the two groups (P>0.05). With CT study performed 3 days after operation, splenic infarction incidence was 15.1% (22/146) in SVP group and 60.0% (21/35) in SVR group, all the patients from two groups recovered within 12 months after operation, which were (3.2±3.0) months and (4.8±3.3) months in SVP and SVR groups, respectively. Conclusions Splenic infarction is the main complication resulted from SPDP with SVP and SVR. Nevertheless, the incidence of postoperative splenic infarction is significantly lower in SVP than SVR. Spleen-preserving distal pancreatectomy with splenic vessel preservation is preferred. Key words: Spleen-preserving; Splenic vessel preservation; Splenic vessel resection; Distal pancreatectomy; Kimura procedure; Warshaw procedure

It's six of one, and half a dozen of the other: splenic vessel preservation and splenic vessel resection in laparoscopic spleen-preserving distal pancreatectomy

It's six of one, and half a dozen of the other: splenic vessel preservation and splenic vessel resection in laparoscopic spleen-preserving distal pancreatectomy

Laparoscopic spleen-preserving distal pancreatectomy with and without splenic vessel preservation – a comparative study

Introduction: Preservation of the spleen with distal pancreatectomy can be performed either with or without preservation of the splenic vessels. This study is to compare the clinical outcomes of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with and without splenic vessel preservation in patients with benign pancreatic lesions. Patients and methods: This is a retrospective analysis of all patients who had undergone LSPDP in our institution during the period Jan 2009–Jun 2015. Patients who underwent LSPDP with splenic vessel preservation (LSPDP-SVP) were compared with those who underwent LSPDP with splenic vessel resection (LSPDP-SVR). The clinical outcomes were compared. Results: Of the 13 patients who underwent LSPDP, LSPDP-SVP was done in 5 patients and LSPDP-SVR in 8 patients. The mean operating time (210vs. 180 minutes) and mean intra-operative bloodloss (250 vs. 160 ml) were significantly lower in SVR group. No procedure was converted to open, but one patient with attempted LSPDP-SVP was converted to LSPDP-SVR because of accidental injury to splenic vein. Mean postoperative hospital stay (7 vs. 8 days) and general postoperative morbidities were similar in both groups. But spleen related morbidities in the form of significant splenic infarction was present in 2 (25%) patients in SVR group and no patients in SVP group. On a median follow up of 34 months (12–70 months) 2 patients in SVR group developed asymptomatic gastric varies with no progression. Conclusion: On comparison, LSDP-SVR is technically easier but spleen related complications are more. The short term benefits associated with the preservation of the splenic vessels should lead to an increased preference for LSPDP-SVP.

Laparoscopic spleen-preserving distal pancreatectomy: Comparative study of spleen preservation with splenic vessel resection and splenic vessel preservation

We sought to evaluate the feasibility of the lateral approach for laparoscopic splenic vessel-preserving distal pancreatectomy (LA-SVPDP).Complete preservation of the splenic vessels is an ideal outcome in spleen-preserving distal pancreatectomy (SPDP). However, the preservation of the vessels is challenging in laparoscopic surgery because the splenic vein is often embedded in the pancreatic parenchyma. Herein we have described LA-SVPDP, the most feasible method for laparoscopic SPDP, and the outcome of our initial experience.Twenty-three patients underwent laparoscopic SPDP. Before we adopted LA-SVPDP, 8 patients underwent the Warshaw method and 6 underwent SVPDP. After the adoption of LA-SVPDP, 8 patients underwent LA-SVPDP and 1 donor underwent the Warshaw method.None of patients undergoing LA-SVPDP required conversion to an open operation, whereas 2 patients undergoing the other procedures were converted to open operations. Five out of 8 patients who underwent the Warshaw method showed engorgement of the gastric veins, revealed by computed tomography. However, only 1 of the 5 patients showed mild gastric varices on endoscopy.Although the Warshaw method is acceptable with a low incidence of gastric varices in our analysis, SVPDP is a feasible approach for SPDP. Our LA-SVPDP technique may contribute to safer and easier SVPDP in laparoscopic surgery.