Kimura Spleen Preserving Subtotal Pancreatectomy
This video was presented at IHPBA New York 2022. In this video we highlighted the technique on how to preserve the spleen and its vessel in a subtotal pancreatectomy.
Transcript
0:00 This is a video presentation on the chem
0:02 technique for dist pancreatctomies
0:04 brought to you by the herpetto
0:05 pancreatic oillary surgery team from
0:07 Unangfong General Hospital Singapore.
0:10 Our patient is a 67year-old Malay lady
0:12 with a BMI of 37 and a significant past
0:15 medical history of asthma, coronary
0:17 [snorts] artery disease and proxismal
0:19 atrial fibrillation. She has been on
0:21 followup with us for about 2 and 1/2
0:23 years for a pancreatic tail cyst that
0:25 has been growing steadily. We decided to
0:27 remove the cyst as it had almost double
0:30 in size.
0:31 We adopted the French position with left
0:33 side up for this surgery and the pots
0:35 were positioned as shown in this
0:36 diagram. Here we have already divided
0:39 the gastrocolic ligament and enter the
0:41 lesser sack which we lay open by
0:42 dissecting along the greater curve of
0:44 the stomach. Next we divide the
0:46 gastropplenic ligament.
0:54 We proceed to dissect the splenic
0:56 flexure sacrificing the inferior polar
0:58 vessel of the spleen and mobilizing it
1:00 from the retroparitonium.
1:11 Here we start to visualize the cystic
1:13 neoplasm which becomes clearer after we
1:15 lift the overlying paronial layer.
1:31 We begin dissecting from the inferior
1:33 border of the pancreas towards the
1:35 spleen.
1:53 We continue our dissection cranially
1:55 lifting the body of the pancreas from
1:57 the retroparitalium until we visualize
1:59 the splenic artery.
2:06 We carefully dissect along the splenic
2:08 artery towards the spleen lifting the
2:10 pancreas off the aenticial of the
2:12 splenic artery.
2:33 A vessel loop is secured over the
2:35 splenic artery.
2:42 We then continue our dissection
2:43 cranially, gently separating the splenic
2:46 artery from the posterior border of the
2:48 pancreas.
2:51 Here
3:00 we begin to visualize the inferior
3:02 border of the splenic vein.
3:05 We free up the anterior border of the
3:07 splenic vein from the posterior part of
3:09 the pancreas.
3:42 After freeing the splanning vein from
3:44 the pancreatic body, a vessel loop is
3:46 secured over it.
3:52 We then resume our dissection of the
3:54 splenic vein off the body of the
3:55 pancreas to create a retropancic tunnel
3:58 that is proximal to the cystic neoplasm.
4:02 We move on to release the superior
4:03 border of the pancreas from the
4:05 retroparitonium. After ensuring the
4:07 retropancic tunnel is large enough to
4:09 pass the stapler through,
4:24 we swing a nylon tape over the pancreas
4:26 to make it easier to lift the pancreas
4:28 interiorly. As we pass the stapler
4:30 through the retropancic tunnel that we
4:32 created,
4:35 we use an echelon flex green reload 60
4:38 mm to transact the pancreatic paranka.
4:50 Thereafter, we continue to dissect the
4:53 rest of the pancreatic body and the tail
4:55 of the splenic vessels.
5:59 We checked our specimen after completing
6:01 our dissection and here you can see that
6:03 on gross examination there’s adequate
6:06 margins between the cystic neoplasm and
6:08 our plane of transsection.
6:14 We then back the specimen.
6:21 We applied tissel glue and nail veil
6:23 over the pancreatic stump and vessels.
6:44 Finally, a black drain was left in Saitu
6:46 over the distal pancreatic bed.
6:50 Her posttop recovery was unremarkable
6:52 and she was discharged home on posttop
6:54 day 7. The hisystologology was reported
6:56 as serious cis adenoma with no evidence
6:58 of malignancy. This completes our
7:00 presentation of the Kimra technique for
7:03 distanctoies.
0:02 technique for dist pancreatctomies
0:04 brought to you by the herpetto
0:05 pancreatic oillary surgery team from
0:07 Unangfong General Hospital Singapore.
0:10 Our patient is a 67year-old Malay lady
0:12 with a BMI of 37 and a significant past
0:15 medical history of asthma, coronary
0:17 [snorts] artery disease and proxismal
0:19 atrial fibrillation. She has been on
0:21 followup with us for about 2 and 1/2
0:23 years for a pancreatic tail cyst that
0:25 has been growing steadily. We decided to
0:27 remove the cyst as it had almost double
0:30 in size.
0:31 We adopted the French position with left
0:33 side up for this surgery and the pots
0:35 were positioned as shown in this
0:36 diagram. Here we have already divided
0:39 the gastrocolic ligament and enter the
0:41 lesser sack which we lay open by
0:42 dissecting along the greater curve of
0:44 the stomach. Next we divide the
0:46 gastropplenic ligament.
0:54 We proceed to dissect the splenic
0:56 flexure sacrificing the inferior polar
0:58 vessel of the spleen and mobilizing it
1:00 from the retroparitonium.
1:11 Here we start to visualize the cystic
1:13 neoplasm which becomes clearer after we
1:15 lift the overlying paronial layer.
1:31 We begin dissecting from the inferior
1:33 border of the pancreas towards the
1:35 spleen.
1:53 We continue our dissection cranially
1:55 lifting the body of the pancreas from
1:57 the retroparitalium until we visualize
1:59 the splenic artery.
2:06 We carefully dissect along the splenic
2:08 artery towards the spleen lifting the
2:10 pancreas off the aenticial of the
2:12 splenic artery.
2:33 A vessel loop is secured over the
2:35 splenic artery.
2:42 We then continue our dissection
2:43 cranially, gently separating the splenic
2:46 artery from the posterior border of the
2:48 pancreas.
2:51 Here
3:00 we begin to visualize the inferior
3:02 border of the splenic vein.
3:05 We free up the anterior border of the
3:07 splenic vein from the posterior part of
3:09 the pancreas.
3:42 After freeing the splanning vein from
3:44 the pancreatic body, a vessel loop is
3:46 secured over it.
3:52 We then resume our dissection of the
3:54 splenic vein off the body of the
3:55 pancreas to create a retropancic tunnel
3:58 that is proximal to the cystic neoplasm.
4:02 We move on to release the superior
4:03 border of the pancreas from the
4:05 retroparitonium. After ensuring the
4:07 retropancic tunnel is large enough to
4:09 pass the stapler through,
4:24 we swing a nylon tape over the pancreas
4:26 to make it easier to lift the pancreas
4:28 interiorly. As we pass the stapler
4:30 through the retropancic tunnel that we
4:32 created,
4:35 we use an echelon flex green reload 60
4:38 mm to transact the pancreatic paranka.
4:50 Thereafter, we continue to dissect the
4:53 rest of the pancreatic body and the tail
4:55 of the splenic vessels.
5:59 We checked our specimen after completing
6:01 our dissection and here you can see that
6:03 on gross examination there’s adequate
6:06 margins between the cystic neoplasm and
6:08 our plane of transsection.
6:14 We then back the specimen.
6:21 We applied tissel glue and nail veil
6:23 over the pancreatic stump and vessels.
6:44 Finally, a black drain was left in Saitu
6:46 over the distal pancreatic bed.
6:50 Her posttop recovery was unremarkable
6:52 and she was discharged home on posttop
6:54 day 7. The hisystologology was reported
6:56 as serious cis adenoma with no evidence
6:58 of malignancy. This completes our
7:00 presentation of the Kimra technique for
7:03 distanctoies.