PANCREAS > Laparoscopic Spleen preserving distal Pancreatectomy

Patient and Port position: Patient placed in modified Lloyd Davies position. Pneumoperitoneum is created by veress needle through 10 mm Supraumbilical skin incision which later on is converted into 10mm camera port.  RUQ 10mm, LUQ 5mm and left antrum axillary line 5mm ports are made.

STEPS:
Initial step is to visualize all quadrants of peritoneal cavity, liver surfaces and primary tumor location for metastasis, lymphadenopathy and ascites. The first step is entry to the lesser sac by dividing the greater omentum below the gastroepiploic arcade starting half way along the greater curvature. Lower border of pancreas identified and dissection started. Splenic vein and artery dissected from the posterior surface of pancreas. Tributaries clipped and divided. Upper surface of pancreas dissected right to left gastric vessels. Pancreas divided by endo GIA stapler (White cartridge) 2cm right to tumor. Specimen dissected from splenic hilum. Specimen put into endobag and extracted from 5cm pfannenstiel incision.