With regards to the pancreatic gland, what division and control techniques do you use (staples, Ligasure device, ultrasound, or regular sutures)?

The solid pseudopapillary tumor of the pancreas, also known as Frantz’s tumor, is an uncommon occurrence usually seen in younger women. It is usually of low grade malignity and most patients have no recurrence after successful surgical resection.
In the last few years, laparoscopic approach to resection procedures for benign pathologies or low-grade malignancies of the pancreas has been increasingly used. The traditional surgical approach to the distal pancreas requires large abdominal incisions because of the deep position of the gland, and entails possible postoperative complications such as wound infections and incisional hernia.
In this video, we present a laparoscopic distal pancreatectomy with splenectomy for a localized tumor of the tail of the pancreas. It shows some steps, which could simplify the technique and prevent some complications as bleeding or postoperative fistula.

The safe feasibility of total laparoscopic pancreaticoduodenectomy has been demonstrated by several authors. In order to achieve it, a 5-port approach is used. Kocher’s maneuver allows to access the inferior vena cava, the subrenal aorta, the posterior plate of the unciform process, and the superior mesenteric artery. Lymph node resection of the region may be performed completely, namely an interaorticocaval lymphadenectomy around the hepatoduodenal ligament and around the coeliac trunk and its branches. After portal vein dissection, the pancreas must be divided distally from the tumor, and its right part must be separated from the portal vein. The duodenal bulb and the first jejunal loop are divided using a linear stapler. After cholecystectomy, the hepatic duct is cut proximally to the cystic duct. Reconstruction will include three anastomoses, a telescoping posterior end-to-side pancreaticogastrostomy, an end-to-side duodenojejunostomy, and an end-to-side hepaticojejunostomy.

The video "Enucleation of a pancreatic nonfunctioning endocrine tumor localized with intraoperative US and augmented reality" authored by B Dallemagne and J Marescaux is analysed by Dr. A Park, sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

The majority of insulinomas are benign, solitary, and are located within the pancreatic parenchyma. Because of the characteristic clinical presentation of hypoglycemia, they are usually diagnosed when they are still small (

Benign inflammatory lesions, cystic neoplasms, and neuro-endocrine tumours in the body and tail of the pancreas are considered good indications for laparoscopic distal pancreatectomy and/or en-bloc pancreatosplenectomy. Laparoscopic resection of malignant neoplasms has raised concern about the radicality of resection and oncological outcomes.
This video demonstrates the technique of laparoscopic radical antegrade pancreatosplenectomy (lap-RAP), which achieves a radical resection with clear circumferential margins. The resection proceeds from right to left to include a coeliac lymphadenectomy, early division of the splenic artery, splenic vein and neck of pancreas, and medial to lateral mobilization of the pancreas posterior to Gerota's fascia to ensure an adequate posterior oncological clearance.
Lap-RAP extends the benefits of laparoscopic pancreatectomy to include malignant lesions in the body and tail of the pancreas.
This video is recommended for experienced laparoscopic surgeons.

We report the case of a 39-year-old woman who underwent morphological examination (CT-scan and MRI) for poorly systematized abdominal pain, which demonstrated the presence of a unilocular macrocystic lesion at the tail of the pancreas. The diagnosis established reported a mucinous cystadenoma, and a robotic distal spleen-preserving pancreatectomy was decided upon.
The dissection is initiated at the inferior border of the pancreas. Dissection has been performed at the level of the splenic hilum with freeing of the pancreatic tail. The splenic branches of the splenic vein are identified at the posterior aspect of the pancreas. These branches are freed progressively. As a result, the distal part of the pancreas is freed from the splenic hilum, and dissection will be performed from left to right. This dissection was decided upon as the lesion is located very distally. The splenic vein and the splenic artery are freed at the level of the hilum. Dissection is continued progressively to the right.
Dissection of the cyst in relation to the splenic vein is uneasy as there are several inflammatory adhesions. Dissection is then performed at the isthmic part of the pancreas. The splenic artery is dissected at the superior border of the pancreas. Dissection is then carried out at the posterior aspect of the pancreas. Considering the presence of adhesions, the operative strategy is changed. It is decided to perform a distal pancreatectomy with preservation of the spleen without vessels preservation. However, the splenic vessels are divided. Consequently, the splenic artery is ligated by a clip and divided. The distal part of the splenic artery is also ligated. Proximally, the splenic vein is dissected and divided. The distal part has also been clipped.
The distal division of arterial and venous vessels is performed. The pancreas was divided at the level of its body. The specimen is placed into a bag and extracted by means of a small Pfannenstiel incision. At the end of the procedure, the spleen appears to be well-vascularized by short vessels. The CT-scan performed on postoperative day 5 demonstrates that the spleen is well-vascularized and rules out the presence of any collection in the place left by pancreatectomy. The postoperative outcome is uneventful. There is no pancreatic fistula. The patient is discharged on postoperative day 7. Pathological findings confirm the presence of a mucinous cystadenoma without any malignancy.

The indications for minimally invasive (MIS) pancreatectomy have slowly increased as experience, techniques, and technology have improved. In this key lecture, Dr. Hansen presents his experience and demonstrates the details of the technique.

In this key lecture, Dr. Kooby provides a brief summary and updates regarding the state-of-the-art experts’ consensus meeting for minimally invasive pancreatic resection (MIPR). He discloses the panel discussion, terminology, and international survey data. He also highlights the registry formation, organizing committee, status of randomized trials in MIPR, other conferences, new publications, and new robotic technology in this context.