Laparoscopic distal splenopancreatectomy for a caudal cystic pancreatic lesion
Epublication WebSurg.com, Apr 2015;15(04). URL: http://websurg.com/doi/vd01en4256
We report the case of a 51-year-old woman who underwent laparoscopic left splenopancreatectomy for a caudal cystic pancreatic lesion evocative of a mucinous cyst. The patient is placed in a right lateral supine position, legs apart. A reverse Trendelenburg position is used. Four ports are placed. After the colon has been detached from the omentum, the dissection is begun at the superior border of the pancreas. It makes it possible to dissect the splenic artery, which is placed on a tape. The dissection is carried on at the inferior border of the pancreas in order to identify the venous mesentericoportal axis. A retropancreatic passage is achieved along the mesentericoportal axis, and a tape is passed around the pancreatic isthmus, which was immediately divided by means of a stapler. The splenic vein is identified at the posterior border of the pancreas. It is dissected and placed on a tape. The splenic artery is divided between two clips. The splenic vein is divided. It is freed from attachments, then clipped, and finally divided. The distal pancreas with the spleen was dissected to perform an ‘en-bloc’ left splenopancreatectomy. The specimen is placed in a bag and extracted through a Pfannenstiel incision, with an extemporaneous exam on the slice, which allows to rule out any neoplastic infiltration. A blade is placed in the left hypochondrium with an amylase activity assay performed on postoperative day 3. The blade is extracted through the leftmost port.