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Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
P Vorwald, A Celdrán, M Posada, G Salcedo, T Georgiev, ML Sánchez de Molina, R Restrepo, S Ayora González
Хирургические операции
4 года назад
1865 просмотров
45 лайков
0 комментариев
10:03
Insulinoma of the pancreatic tail: left pancreatic resection with preservation of the spleen
This video shows a left pancreatic resection with splenic preservation in a 56-year-old woman. The patient has a visible insulinoma (1cm in diameter) located at the lower border of the pancreatic tail. The pancreatic tail is 3 to 4cm distant to the splenic hilum, which facilitates the dissection. Trocar position is similar to the one used in gastric laparoscopic surgery. First, the gastrocolic ligament is divided, and the stomach is retracted to the right side of the patient, along with the left lobe of the liver. After dissection of retrogastric adhesions, the peritoneum is incised on the lower border of the pancreas to get access to the retropancreatic area. The splenic artery is dissected on the upper pancreatic border and encircled with a vessel loop. The last retropancreatic attachments are taken down and the splenic vein is dissected and encircled with a vessel loop. Once the splenic vessels are retracted, the pancreatic transection is performed with a linear stapler. The last adhesions from the pancreatic tail to the splenic vessels are dissected with the LigaSure™ vessel-sealing device, making sure to preserve the splenic vessels. Finally, the resected pancreatic tail is placed in a specimen retrieval bag (Endobag®) and extracted through the trocar incision in the upper left abdomen. Hemostasis is checked while making sure that splenic perfusion is adequate.
Laparoscopic central pancreatectomy for insulinoma
We report the case of a 43-year-old male patient who was diagnosed with insulinoma and had a robotic enucleation of an isthmic pancreatic tumor in November 2012. However, the patient presents with clinical recurrences of hypoglycemia 18 months later. Re-evaluation studies demonstrated a local recurrence. A laparoscopic central pancreatectomy was indicated. The procedure started with the opening of the lesser sac. The splenic vessels were dissected and controlled. A retropancreatic passage along the venous mesenterico-portal axis was performed. Ultrasonography was carried out to assess the pancreatic recurrence area. The pancreas isthmus was transected. A pancreaticogastric anastomosis was performed at the posterior aspect of the stomach. The resected specimen confirms the recurrence of an insulinoma, which has been entirely removed.
P Pessaux, J Teyssedou, D Ntourakis, M Vix, J Marescaux
Хирургические операции
5 лет назад
1353 просмотра
31 лайк
0 комментариев
09:21
Laparoscopic central pancreatectomy for insulinoma
We report the case of a 43-year-old male patient who was diagnosed with insulinoma and had a robotic enucleation of an isthmic pancreatic tumor in November 2012. However, the patient presents with clinical recurrences of hypoglycemia 18 months later. Re-evaluation studies demonstrated a local recurrence. A laparoscopic central pancreatectomy was indicated. The procedure started with the opening of the lesser sac. The splenic vessels were dissected and controlled. A retropancreatic passage along the venous mesenterico-portal axis was performed. Ultrasonography was carried out to assess the pancreatic recurrence area. The pancreas isthmus was transected. A pancreaticogastric anastomosis was performed at the posterior aspect of the stomach. The resected specimen confirms the recurrence of an insulinoma, which has been entirely removed.
Spleen and splenic vessel preserving distal pancreatectomy for bifocal PNET in a young patient with MEN1
In this key lecture, Dr. Conrad outlines key steps related to spleen and splenic vessel preserving distal pancreatectomy, laparoscopic insulinoma enucleation of the posterior pancreatic neck, and laparoscopic partial splenectomy. He stresses the technical aspects of intraoperative ultrasonography, celiac trunk dissection, and gives some recommendations with regards to leak reduction, vascular dissection, and energy device use. He provides tips and tricks for insulinoma dissection and emphasizes key concepts and technical points for main pancreatic duct preservation, hilum dissection, and spleen transection.
C Conrad
Лекции
2 года назад
1016 просмотров
67 лайков
0 комментариев
15:24
Spleen and splenic vessel preserving distal pancreatectomy for bifocal PNET in a young patient with MEN1
In this key lecture, Dr. Conrad outlines key steps related to spleen and splenic vessel preserving distal pancreatectomy, laparoscopic insulinoma enucleation of the posterior pancreatic neck, and laparoscopic partial splenectomy. He stresses the technical aspects of intraoperative ultrasonography, celiac trunk dissection, and gives some recommendations with regards to leak reduction, vascular dissection, and energy device use. He provides tips and tricks for insulinoma dissection and emphasizes key concepts and technical points for main pancreatic duct preservation, hilum dissection, and spleen transection.
Laparoscopic left pancreatectomy with spleen preservation for multiple neuroendocrine tumors
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.
B Dallemagne, D Mutter, L Soler, J Marescaux
Хирургические операции
6 лет назад
2770 просмотров
77 лайков
1 комментарий
35:52
Laparoscopic left pancreatectomy with spleen preservation for multiple neuroendocrine tumors
Insulinoma is the most common functional neuroendocrine tumor of the pancreas. Most insulinomas are benign and solitary. Surgical resection is preferred for insulinomas and cure is achieved in more than 90% of the patients. Successful surgery requires accurate localization based on contrast enhanced CT-scan, PET-scan, and intraoperative ultrasound. This video shows a laparoscopic left pancreatectomy in a young patient presenting with typical symptoms evocative of Whipple's triad. Preoperative imaging studies identified two pancreatic tumors. Laparoscopic exploration and ultrasound identified four distinct tumors, all of them expressing somatostatin and insulin. This clinical case highlights the necessity and value of ultrasound exploration during surgery for neuroendocrine tumors.
Laparoscopic distal pancreatectomy and enucleation
Pancreatic endocrine tumors (PETs) are rare tumors (1 per 100,000 population). They occur, or are at least discovered, most commonly in the fourth and fifth decade of life with a slight female predominance. They are classified as functioning (70% of cases) if responsible for a clinical syndrome related to hormonal release, or non-functioning if there are no hormone-related symptoms attributable to the tumor (15-30% of cases). The most common PETs are insulinomas and gastrinomas. Insulinomas are found within the pancreas more than 90% of the time. In this lecture, Professor Dallemagne shows the laparoscopic treatment of these lesions.
B Dallemagne
Лекции
8 лет назад
2853 просмотра
32 лайка
0 комментариев
15:06
Laparoscopic distal pancreatectomy and enucleation
Pancreatic endocrine tumors (PETs) are rare tumors (1 per 100,000 population). They occur, or are at least discovered, most commonly in the fourth and fifth decade of life with a slight female predominance. They are classified as functioning (70% of cases) if responsible for a clinical syndrome related to hormonal release, or non-functioning if there are no hormone-related symptoms attributable to the tumor (15-30% of cases). The most common PETs are insulinomas and gastrinomas. Insulinomas are found within the pancreas more than 90% of the time. In this lecture, Professor Dallemagne shows the laparoscopic treatment of these lesions.