{"title":"腹腔镜保留脾脏血管的胰腺远端切除术的下内侧入路","authors":"Kee Tae Park, Joo Dong Kim","doi":"10.4293/JSLS.2024.00028","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Complete preservation of the splenic vessels is ideal during laparoscopic spleen-preserving distal pancreatectomy (LSPDP). However, this remains challenging and time-consuming because the vessels are often deeply embedded in the pancreatic parenchyma. Herein, we introduce our inferior-medial approach to laparoscopic splenic vessel-preserving distal pancreatectomy (lap-SVPDP) and evaluate its safety and feasibility.</p><p><strong>Methods: </strong>Forty-three patients underwent LSPDP performed by a single surgeon at our institution: 26 (60.5%) lap-SVPDPs with an inferior-medial approach and 17 with the laparoscopic Warshaw technique (lap-WT). We compared the outcomes of the 2 groups. No patient undergoing lap-SVPDP required conversion to laparotomy or lap-WT.</p><p><strong>Results: </strong>Most preoperative characteristics and postoperative outcomes did not differ between the 2 groups; neither the operation time nor the intraoperative blood loss differed despite the greater technical complexity of lap-SVPDP. The mean tumor size was greater in the lap-WT than the lap-SVPDP group (<i>P </i>=<i> </i>.001). The splenic vein patency rate of the lap-SVPDP group was not inferior to that of the open SVPDP group treated by the same surgeon.</p><p><strong>Conclusion: </strong>Inferior-medial approach lap-SVPDP could be a safe and feasible technique for lap-SVPDP; neither blood loss nor operation time is increased.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495858/pdf/","citationCount":"0","resultStr":"{\"title\":\"Inferior-Medial Approach to Laparoscopic Splenic Vessel-Preserving Distal Pancreatectomy.\",\"authors\":\"Kee Tae Park, Joo Dong Kim\",\"doi\":\"10.4293/JSLS.2024.00028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Complete preservation of the splenic vessels is ideal during laparoscopic spleen-preserving distal pancreatectomy (LSPDP). However, this remains challenging and time-consuming because the vessels are often deeply embedded in the pancreatic parenchyma. Herein, we introduce our inferior-medial approach to laparoscopic splenic vessel-preserving distal pancreatectomy (lap-SVPDP) and evaluate its safety and feasibility.</p><p><strong>Methods: </strong>Forty-three patients underwent LSPDP performed by a single surgeon at our institution: 26 (60.5%) lap-SVPDPs with an inferior-medial approach and 17 with the laparoscopic Warshaw technique (lap-WT). We compared the outcomes of the 2 groups. No patient undergoing lap-SVPDP required conversion to laparotomy or lap-WT.</p><p><strong>Results: </strong>Most preoperative characteristics and postoperative outcomes did not differ between the 2 groups; neither the operation time nor the intraoperative blood loss differed despite the greater technical complexity of lap-SVPDP. The mean tumor size was greater in the lap-WT than the lap-SVPDP group (<i>P </i>=<i> </i>.001). The splenic vein patency rate of the lap-SVPDP group was not inferior to that of the open SVPDP group treated by the same surgeon.</p><p><strong>Conclusion: </strong>Inferior-medial approach lap-SVPDP could be a safe and feasible technique for lap-SVPDP; neither blood loss nor operation time is increased.</p>\",\"PeriodicalId\":17679,\"journal\":{\"name\":\"JSLS : Journal of the Society of Laparoendoscopic Surgeons\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495858/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JSLS : Journal of the Society of Laparoendoscopic Surgeons\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4293/JSLS.2024.00028\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4293/JSLS.2024.00028","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
Inferior-Medial Approach to Laparoscopic Splenic Vessel-Preserving Distal Pancreatectomy.
Background and objectives: Complete preservation of the splenic vessels is ideal during laparoscopic spleen-preserving distal pancreatectomy (LSPDP). However, this remains challenging and time-consuming because the vessels are often deeply embedded in the pancreatic parenchyma. Herein, we introduce our inferior-medial approach to laparoscopic splenic vessel-preserving distal pancreatectomy (lap-SVPDP) and evaluate its safety and feasibility.
Methods: Forty-three patients underwent LSPDP performed by a single surgeon at our institution: 26 (60.5%) lap-SVPDPs with an inferior-medial approach and 17 with the laparoscopic Warshaw technique (lap-WT). We compared the outcomes of the 2 groups. No patient undergoing lap-SVPDP required conversion to laparotomy or lap-WT.
Results: Most preoperative characteristics and postoperative outcomes did not differ between the 2 groups; neither the operation time nor the intraoperative blood loss differed despite the greater technical complexity of lap-SVPDP. The mean tumor size was greater in the lap-WT than the lap-SVPDP group (P =.001). The splenic vein patency rate of the lap-SVPDP group was not inferior to that of the open SVPDP group treated by the same surgeon.
Conclusion: Inferior-medial approach lap-SVPDP could be a safe and feasible technique for lap-SVPDP; neither blood loss nor operation time is increased.
期刊介绍:
JSLS, Journal of the Society of Laparoscopic & Robotic Surgeons publishes original scientific articles on basic science and technical topics in all the fields involved with laparoscopic, robotic, and minimally invasive surgery. CRSLS, MIS Case Reports from SLS is dedicated to the publication of Case Reports in the field of minimally invasive surgery. The journals seek to advance our understandings and practice of minimally invasive, image-guided surgery by providing a forum for all relevant disciplines and by promoting the exchange of information and ideas across specialties.