Papatriantafyllou Andreas, Mavromatis Theodoros, Demestiha Theano, Filippou Dimitrios, Skandalakis Panagiotis
3rd Department of Surgery, Evangelismos General Hospital, Athens, Greece.
Department of Anatomy, Medical School, University of Athens, Athens, Greece.
Case Rep Surg. 2018 Feb 19;2018:1978362. doi: 10.1155/2018/1978362. eCollection 2018.
Spleen preserving laparoscopic distal pancreatectomy is considered as first choice operation for symptomatic benign or small malignant lesions located at the body or tail of the pancreas. The two main surgical techniques that have been proposed and widely adopted for spleen preserving laparoscopic distal pancreatectomy are the Warshaw and Kimura techniques. A novel modified approach for laparoscopic spleen preserving distal pancreatectomy is presented. The technique was initially performed in a 57-year-old female patient with mucinous cystadenoma. Following the surgical planes created by the fascia fusion and the organ rotation during embryogenesis (fascia of Toldt and renal fascia) with the patient in a right lateral decibutus position, the tumor was accessed retroperitoneally, without dividing the gastrocolic ligament and entering the lesser sac. The tail of the pancreas was mobilized anteriorly and medially, the lesion was visually identified and resected, and short gastric and left gastroepiploic vessels were preserved. We present the technical details and tips; we define the surgical anatomy of it and discuss the perioperative course of the patient as well as the possible benefits of the proposed technique. The proposed technique seems to be safe, easy to perform, and may present a promising alternative approach for patients with pancreatic disease that can be treated by laparoscopic pancreatectomy.
保留脾脏的腹腔镜远端胰腺切除术被认为是治疗位于胰腺体部或尾部的有症状良性或小恶性病变的首选手术。对于保留脾脏的腹腔镜远端胰腺切除术，已提出并广泛采用的两种主要手术技术是Warshaw技术和Kimura技术。本文介绍了一种用于腹腔镜保留脾脏远端胰腺切除术的新型改良方法。该技术最初在一名患有黏液性囊腺瘤的57岁女性患者身上实施。让患者处于右侧卧位，沿着胚胎发育过程中由筋膜融合和器官旋转形成的手术平面（Toldt筋膜和肾筋膜），经腹膜后途径显露肿瘤，不切断胃结肠韧带，不进入小网膜囊。将胰腺尾部向前和内侧游离，直视下识别并切除病变，保留胃短血管和胃网膜左血管。我们介绍了技术细节和技巧；明确了其手术解剖结构，并讨论了患者的围手术期过程以及该技术可能带来的益处。所提出的技术似乎安全、易于实施，对于可通过腹腔镜胰腺切除术治疗的胰腺疾病患者可能是一种有前景的替代方法。
