Laparoscopic radical antegrade pancreatosplenectomy
Epublication WebSurg.com, Nov 2008;08(11). URL: http://websurg.com/doi/vd01en2464
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.