Reduced Port Distal Pancreatectomy for Giant Pancreatic Neoplasm: Beyond the Event Horizon and Back

Abstract

Backgound:

Giant pancreatic masses in the pediatric population are managed with resection when feasible. When located in the distal pancreas, a distal pancreatectomy with splenic preservation is typically the ideal approach. Multiport laparoscopic surgery has been effective in small- to moderate-sized lesions.

Objective:

We report a reduced port approach to a giant neoplasm at the tail of the pancreas treated with distal pancreatectomy and splenic preservation.

Materials and Methods:

A 15-year-old otherwise healthy male with left upper quadrant fullness, nausea, and vomiting. A CT scan and MRI showed a 10 cm mass at the tip of the pancreas. Tumor markers were negative. The patient had already undergone an open appendectomy previously and was concerned about cosmesis. A single-incision approach was therefore employed for the resection. Straight stick laparoscopic instruments and a vessel sealing device were used.

Results:

Intraoperatively, the mass was densely adherent to the surrounding structures. The dissection of the distal splenic vein and artery proved to be extremely challenging using this approach. An additional 5 mm port was placed in the left lower quadrant, which improved triangulation and facilitated completion of the procedure. The site was subsequently used for a flat suction drain. A distal pancreatectomy was effectively performed along with complete preservation of the splenic artery and vein. The specimen was removed through the umbilicus and the resulting cosmesis excellent.

Conclusion:

Single-incision distal pancreatectomy with splenic preservation for large tumors is technically demanding with straight instruments. Early addition of a port at a proposed drain site can facilitate the dissection significantly. Reduced port surgery, however, may still have a role in select cases.

The authors have nothing to disclose.

Runtime of video: 4 mins 33 secs