Pancreatic fistula (PF) remains the primary source of morbidity after distal pancreatectomy (DP). There is currently no optimal stump closure technique to reduce PF rates. We present a novel technique for pancreatic stump closure using Clip Ligation of the duct and Associated Suturing of Pancreas (CLASP). Five patients (three females) with a median age of 65 years underwent DP and splenectomy for pancreatic body or tail tumour using the CLASP technique. Four of those operations were done laparoscopically. Only one patient developed grade A PF. No other postoperative complications were noticed. The mean length of stay was 5.4 days. The CLASP technique was applicable in both laparoscopic and open distal pancreatectomy. The key points include mobilisation of the pancreatic body from the retroperitoneum and division of the parenchyma with energy device. The technique of pancreatic stump closure involves the isolation of the pancreatic duct (PD), application of a double ligaclip on the proximal duct, division of the PD and finally suturing of the pancreatic stump. The CLASP technique is an effective and safe alternative technique to the current traditional methods of pancreatic stump closure.

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Conclusion: The intra-and postoperative course was uneventful; the patient could be discharged on postoperative day eleven. The histopathological findings showed an R0 resection.

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The progresses made in minimally invasive surgery, make it not only possible to perform isolated cholecystectomy, but also to provide a totally laparoscopic treatment of common bile duct lithiasis. In this approach, the use of choledochoscopy is indispensable for both diagnostic and therapeutic success. In our department, cholecystectomy and laparoscopic exploration of the bile duct is the treatment of choice for cholelithiasis with associated lithiasis of the main bile duct. We describe the use of a flexible and disposable endoscope, designed for bronchofibroscopy and tracheal intubation, on patients who needed to undergo choledochoscopy. We used Ambu's aScope 3Ô, the large version of the device, which is 60 cm long, 5.8 mm in diameter, and has a 2.8 mm ID work channel that allows the passage of Dormia baskets for bile instrumentation. The LED light source is located at the tip of the device, which has a flexing capacity of 140 upwards and 110 downwards. The image is reproduced on an 8.5", TFT/LCD monitor. Using reusable videoendoscopes for that purpose always raises the question of the ergonomy of use, and easy image capture. In that respect, the Ambu Ò aScope 3Ô clearly exceeded the challenge. The image quality is also comparable to that of conventional choledochoscopes. Using these endoscopes has other advantages: no high costs of repair, no decontamination costs, and no cross infection. This endoscope proved to be easy to use and shows promise while performing choledochoscopy for treatment of coledocholithiasis via laparoscopic approach.