-Report on Experiments and Clinical Cases-

A Safe Technique for Laparoscopic Distal Pancreatectomy Involving a Large Cystic Tumor

Yoshiharu Nakamura, Satoshi Matsumoto, Takashi Tajiri and Eiji Uchida

Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School

Background: In patients with large tumors, securing sufficient working space to perform laparoscopic resection can be difficult. The purpose of this technical note is to describe a technique for easy performance of laparoscopic distal pancreatectomy involving large cystic pancreatic tumors.
Surgical Technique: Early in surgery, a small incision was made in the abdominal wall directly above the tumor to remove the laparoscopically resected tissues from the abdominal cavity. After the margin of the incision was secured with a wound protector, a double-balloon catheter was used to remove the contents of the tumor under direct observation, without allowing any leakage into the abdominal cavity. The volume of the tumor could, thus, be safely reduced. As a result, laparoscopic distal pancreatectomy was safely performed, even for 17-cm-diameter mucinous cystic neoplasm of the pancreas.
Conclusion: A wound protector and a double-balloon catheter are helpful for removing the contents of a cystic tumor. A small abdominal incision for removing the resected tissues can be used during the resection procedure to aspirate the tumor contents, and, as a result, laparoscopic distal pancreatectomy can be performed safely, even for large cystic pancreatic tumors.

J Nippon Med Sch 2011; 78: 374-378

Keywords
laparoscopic distal pancreatectomy, large cystic tumor, mucinous cystic neoplasm, pancreas, laparoscopic surgery

Correspondence to
Yoshiharu Nakamura, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
keishun@nms.ac.jp

Received, August 9, 2011
Accepted, August 22, 2011