Distal pancreatic resection via laparo-endoscopic single site surgery – development of the technique

Aim : To present a novel technique of a laparo-endoscopic single site (LESS) distal pancreatic resection via the umbilicus with use of the QuadPortTM Access System.

Material and methods : The technique of distal pancreatic resection through a 30 mm longitudinal incision in the umbilicus is described. Medial to lateral approach of pancreas preparation using a harmonic scalpel and regular laparoscopic instruments is applied. The described technique was successfully applied in a 26-year-old female patient with tumour of the pancreatic body and tail (90/41/27 mm). Pancreatectomy was followed by splenectomy due to infiltration of the splenic vessels.

Results : Total operative time was 160 min. Blood loss was 800 ml. Initial wound size was 30 mm. Splenic vein and artery infiltration forced augmentation of the wound to 80 mm. The patient required only per request medication. Peristalsis returned spontaneously on the first postoperative day. Hospital stay was 4 days. There were no early perioperative complications. The patient required readmission due to electrolyte imbalance 7 weeks after the operation.

Conclusions : The proposed operative technique of single incision laparoscopic distal pancreatectomy is difficult and challenging. Nonetheless, the authors proved that it is safe and feasible when performed by an experienced laparoscopic team.