Abstract
Background
The gastrohepatic ligament approach is a form of robot-assisted spleen-preserving distal pancreatectomy (SPDP).1,2 This approach does not require omentum transection, peri-splenic dissection, or stomach traction.
Methods
Considering the advantages of preserving collateral pathways around the spleen, the authors performed the gastrohepatic ligament approach in laparoscopic SPDP while preserving splenic vessels (LSPDP), with specific modifications for laparoscopic surgery. The following surgical technique was performed. First, the gastrohepatic ligament was divided extensively, and all subsequent procedures were performed through the gastrohepatic ligament route. The superior and inferior borders of the pancreas then were dissected to encircle the common hepatic and splenic arteries with vessel loops and to expose the superior mesenteric vein (SMV) and portal vein. After taping of the pancreas on the SMV, the pancreas was divided using a linear stapler. Next, the pancreas was dissected from proximal to distal with preservation of the splenic vessels. Re-taping and traction of the splenic vessels and pancreas could facilitate the dissection of the pancreas body, especially at the splenic hilum. The appropriate counter traction using traction tapes allowed efficient laparoscopic procedures. The LSPDP was performed for three patients, including one obese patient (body mass index, 36 kg/m2) and two patients with an anomalous left hepatic artery branching from the left gastric artery.
Results
The mean operation time was 186 min, and the intraoperative blood loss was 37 mL.
Conclusion
The gastrohepatic ligament approach could be an option for performing LSPDP with the counter traction technique for low-grade malignant tumors.
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References
Takagi K, Umeda Y, Yoshida R, Yagi T, Fujiwara T. The gastrohepatic ligament approach in robotic spleen-preserving distal pancreatectomy with resection of the splenic vessels: the superior window approach in the Warshaw technique. J Gastrointest Surg. 2022;26:1342–4.
Takagi K, Yoshida R, Umeda Y, Fuji T, Yasui K, Yagi T, et al. Robotic spleen-preserving distal pancreatectomy with preservation of splenic vessels using the gastrohepatic ligament approach: the superior window approach in the Kimura technique. Dig Surg. 2022;39:137–40.
Acknowledgment
We thank Editage (www.editage.jp) for English language editing.
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All authors are in agreement with the content of the manuscript. Each author's contribution is as follows; MT; study conception and design, acquisition of data, and drafting of manuscript. RH, TH, and YS; acquisition of data, and revising of the manuscript. SO, and TI; study conception and design and critical revision of the manuscript.
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The current study was approved by the Institutional Ethics Committee of the Saku Central Hospital Advanced Care Center (Registration No. R201802-01) and conformed to the ethical guidelines of the Declaration of Helsinki.
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Tsunematsu, M., Onda, S., Hamura, R. et al. The Gastrohepatic Ligament Approach Using Multiple Traction Tapes in Laparoscopic Spleen-Preserving Distal Pancreatectomy with Preservation of Splenic Vessels (with Video). Ann Surg Oncol 31, 1358–1359 (2024). https://doi.org/10.1245/s10434-023-14558-1
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DOI: https://doi.org/10.1245/s10434-023-14558-1