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General and digestive surgery

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.
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
Surgical intervention
3 years ago
1759 views
44 likes
0 comments
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
Surgical intervention
4 years ago
1262 views
30 likes
0 comments
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.