Efficacy of the Electrothermal Bipolar Vessel Sealer in Laparoscopic Spleen-Preserving Distal Pancreatectomy with Conservation of the Splenic Artery and Vein

Suzuki, On; Tanaka, Eiichi; Hirano, Satoshi; Suzuoki, Masato; Hashida, Hideaki; Ichimura, Tsuyoshi; Sagawa, Noriaki; Shichinohe, Toshiaki; Kondo, Satoshi

doi:10.1007/s11605-008-0676-7

Cited by 14 publications

(10 citation statements)

References 11 publications

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“…In the CLPD method, LDP was performed as previously described [10][11][12] . The operator used a right-lateral side trocar and umbilical trocar, and a right-inferior side trocar was used as a camera port ( fig.…”

Section: Ldp Using the Conventional Methodsmentioning

confidence: 99%

The Straightened Splenic Vessels Method Improves Surgical Outcomes of Laparoscopic Distal Pancreatectomy

Nagakawa

Sahara²,

Hosokawa³

et al. 2017

Dig Surg

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Background: In laparoscopic distal pancreatectomy (LDP), isolating the splenic artery and vein requires advanced techniques. This study aimed to assess the efficacy of a novel method termed the ‘straightened splenic vessels' (SSV) method for isolating the splenic vessels in LDP. Methods: In SSV, to adjust the instrument axis, the splenic artery was straightened by grasping 2 points of its nerve sheath. Then, the layer between the splenic artery's nerve sheath and the pancreatic parenchyma was dissected. Next, the pancreas was mobilized from body to tail, and the splenic vein was straightened by 3-point retraction before isolation. To evaluate this method's efficacy, we investigated 51 patients who underwent LDP. Results: In 39 patients who underwent LDP with splenectomy, the mean operating time was significantly shorter in the SSV group than in the conventional group (p = 0.004). In 12 patients who underwent LDP with preserving the splenic vessels, the mean intraoperative blood loss in the SSV group was 27.6 ml, which was significantly lower than that in the conventional group (p = 0.012). Conclusion: This method may be applied as a standard procedure with little blood loss and short operation time for LDP. Larger prospective studies are needed to further evaluate the feasibility.

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Section: Ldp Using the Conventional Methodsmentioning

confidence: 99%

The Straightened Splenic Vessels Method Improves Surgical Outcomes of Laparoscopic Distal Pancreatectomy

Nagakawa

Sahara²,

Hosokawa³

et al. 2017

Dig Surg

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“…a.The anterior pararenal space was reached via the lateral approach, after the perirenal fascia beside the peritoneal fold was opened. b The anterior renal fascia, peritoneum, and lateroconal fascia were clipped by Hem-o-LoK clips, and the anterior pararenal space was reached via the regular posterior approach splenic vessels can be avoided by dissecting the pancreatic tissue away from the splenic vessels and dividing the branches of the splenic vessels with the neighboring pancreatic tissues [20]. It is also necessary to avoid the pulsatile site of the splenic vessels when opening the anterior renal fascia.…”

Section: Discussionmentioning

confidence: 99%

Two Anatomical Pathways for Retroperitoneoscopic Pancreatectomy: Indications for the Posterior and Lateral Approaches

Zhao

Liu

et al. 2014

World j. surg.

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RP using the posterior or lateral approach is feasible and effective, but has different indications. The posterior approach is useful for distal pancreatectomy, as well as resection of pancreatic lesions in the posterior or superoposterior region of the distal pancreas. The lateral approach is useful for resection of pancreatic lesions in the anterior or inferior region of the body and tail. The two approaches can be used in combination or conversion.

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“…In particular, small branches to the SpV are more frequent than those from the SpA, and it is often more difficult to deal with small branches of the vein rather than the artery. There are some reports on surgical techniques using a vessel‐sealing system for these small branches of veins 53,54 . In this regard, robotic surgery is capable of precision operation and increases the rate of spleen preservation, reducing the length of hospital stay and decreasing the conversion rate, with a comparable rate of postoperative complications 55,56 .…”

Section: Discussionmentioning

confidence: 99%

“…There are some reports on surgical techniques using a vessel-sealing system for these small branches of veins. 53,54 In this regard, robotic surgery is capable of precision operation and increases the rate of spleen preservation, reducing the length of hospital stay and decreasing the conversion rate, with a comparable rate of postoperative complications. 55,56 In contrast, it has been reported that the conversion rate of laparoscopic surgery is the same as that of robotic surgery, and the operative time of robotic surgery is longer than that of laparoscopic surgery.…”

Section: Artery First Approaches In Midpmentioning

confidence: 99%

Surgical approaches for minimally invasive distal pancreatectomy: A systematic review

Ban

Garbarino

Ishikawa

et al. 2021

J Hepato Biliary Pancreat

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Background Minimally invasive distal pancreatectomy (MIDP) was initially performed for benign tumors, but recently its indications have steadily broadened to encompass other conditions including pancreatic malignancies. Thorough anatomical knowledge is mandatory for precise surgery in the era of minimally invasive surgery. However, expert consensus regarding anatomical landmarks to facilitate the safe performance of MIDP is still lacking. Methods A systematic literature search was performed using keywords to identify articles regarding the vascular anatomy and surgical approaches/techniques for MIDP. Results All of the systematic reviews revealed that MIDP was not associated with an increase in postoperative complications. Moreover, most showed that MIDP resulted in less blood loss than open surgery. Regarding surgical approaches for MIDP, a standardized stepwise procedure improved surgical outcomes, including blood loss, operative time, and major complications. There are two approaches to the splenic vessels, superior and inferior; however, no study has ever directly compared them with respect to clinical outcomes. The morphology of the splenic artery affects the difficulty of approaching the artery's root. To select an appropriate dissecting layer when performing posterior resection, thorough knowledge of the anatomy of the fascia, left renal vein/artery, and left adrenal gland is needed. Conclusions In MIDP, a standardized approach and precise knowledge of anatomy facilitates safe surgery and has the advantage of a shorter learning curve. Anatomical features and landmarks are particularly important in cases of radical MIDP and splenic vessel preserving MIDP.

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Efficacy of the Electrothermal Bipolar Vessel Sealer in Laparoscopic Spleen-Preserving Distal Pancreatectomy with Conservation of the Splenic Artery and Vein

Abstract: Use of the EBVS is safe and efficient in LSPDP with conservation of the splenic vessels.

Cited by 14 publications

References 11 publications

The Straightened Splenic Vessels Method Improves Surgical Outcomes of Laparoscopic Distal Pancreatectomy

The Straightened Splenic Vessels Method Improves Surgical Outcomes of Laparoscopic Distal Pancreatectomy

Two Anatomical Pathways for Retroperitoneoscopic Pancreatectomy: Indications for the Posterior and Lateral Approaches

Surgical approaches for minimally invasive distal pancreatectomy: A systematic review

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