Laparo-Endoscopic Single Site (LESS) Distal Pancreatectomy and Splenectomy with an Extraction Port

Laparo-Endoscopic Single Site (LESS) surgery provides satisfactory access to all quadrants of the abdomen, and thereby, can be efficaciously applied to a broad range of operations providing the salutary benefits of multi-incisional laparoscopy and superior cosmesis. This video documents that LESS surgery is applicable for a safe, expeditious, and efficacious distal pancreatectomy with splenectomy.

After bupivacaine was injected into the umbilicus, a single 12mm incision was made without violating the umbilical ring. A 5mm deflectable tip laparoscope was utilized. The stomach was widely mobilized and the gastrocolic omentum was divided utilizing bipolar cautery, achieving wide access to the pancreas. A liver retractor lifted the liver and mobilized the stomach away from the pancreas, providing adequate exposure to the left gastric artery, an important landmark. The dissection was carried along the inferior border of the pancreas toward the caudal tip of the spleen. The splenic flexure of the colon was mobilized. The pancreas was divided utilizing a laparoscopic articulating stapler. The specimen was freed by dividing lienophrenic ligaments and removed in an extraction bag. Hemostasis was achieved and 10ml of dilute bupivacaine solution was sprayed over the subdiaphragmatic spaces prior to specimen extraction. With liberal use of water-soluble lubricant at a lateral incision extraction site, it is possible to extract a large specimen through a small incision. The umbilicus, as well as the lateral incision, was closed with absorbable sutures in a figure-of-eight fashion. After recovery, there was no notable scar.

Alexander S. Rosemurgy MD1, Harold Paul MS1, Kenneth Luberice BS1, Edward Choung MD1, Sharona B. Ross MD2

1Tampa General Medical Group, Tampa General Hospital, Tampa, Florida
2University of South Florida, Department of Surgery, Tampa, Florida