| International Session (Symposium) 4 (JSGS・JSH) |
| Fri. November 2nd 9:40 - 12:00 Room 12: Kobe International Conference Center Main Hall |
| A novel strategy 'Retlap' for difficult cases in laparoscopic distal pancreatectomy | |||
| Gozo Kiguchi1, Masayuki Kojima1, Atsushi Sugioka1 | |||
| 1Department of Surgery, Fujita Health University | |||
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| 【Introduction】 Laparoscopic distal pancreatectomy(LDP) has been proven safe and effective. But there are some cases which are difficult to be performed in laparoscopically, such as borderline resectable pancreatic body cancer and huge pancreatic body tumor. To overcome the difficulty in such cases, we have developed a new strategy named ‘Retroperitoneal first laparoscopic approach(Retlap)’. 【Methods】 We have applied Retlap to the difficult cases: borderline resectable pancreatic body cancer(BRPC), huge tumor and benign tumor which has good indication for spleen-preserving distal pancreatectomy(SPDP). In Retlap for BRPC, we identify the origin of the celiac axis and the superior mesenteric artery(SMA) at the back side of the left kidney using retroperitoneoscopy early in the operation, and then we are able to confirm the resectability for negative surgical margin by frozen section. In Retlap for huge tumor, we dissect the posterior side of Gerota’s fascia using retroperitoneoscopy, mobilize the pancreatic body without exposing the huge tumor, and then we are able to identify the root of the splenic artery without interference of the huge tumor. In Retlap for SPDP, we dissect the anterior side of Gerota’s fascia using retroperitoneoscopy, mobilize the pancreatic body, and then we are able to expose the splenic artery and vein widely without interference of the pancreatic body in dorsal view. 【Results】 Retlap enabled us to achieve the excellent operative view without interference of the tumor or the pancreatic body. Retlap helped us to identify the vessels: the celiac axis, the SMA, the splenic artery and the splenic vein quite easily in difficult cases. 【Conclusions】 Retlap is a suitable approach for difficult cases in LDP. |
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Index Term 1: laparoscopic distal pancreatectomy Index Term 2: Retroperitoneal |
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