Hand-assisted laparoscopic distal pancreatectomy with minilaparotomy for distal pancreatic cystadenoma

Two patients with cystic tumors of the pancreas treated by laparoscopic dis tal pancreatectomy are presented. The first patient was a 34-year-old woman with a 6-cm cystadenoma of the tail of the pancreas treated with a complet e laparoscopic distal pancreatectomy. After mobilization of the distal panc reas and spleen, the pancreas was transected proximally together with the s plenic artery and vein using an endoscopic linear stapler. The second patie nt was a 71-year-old woman with a 6-cm cystadenoma of the body of the pancr eas, treated by hand-assisted laparoscopic distal pancreatectomy with minil aparotomy because the tumor was adjacent to the portal vein and celiac axis . Using an upper median minilaparotomy, dissection of the gastrocolic ligam ent, division of the splenic artery, and transection and closure of the pan creas were performed. Division of the splenic vein and mobilization of the distal pancreas and spleen were performed via a hand-assisted laparoscopic approach. There were no postoperative complications (such as pancreatic fis tulas) in either patient, and the postoperative courses were uneventful. Th e patients returned to normal activity within 1 week after the operation. C omplete laparoscopic and hand-assisted laparoscopic distal pancreatectomy a re preferable to conventional open surgery for benign tumors of the pancrea s because of their less-invasive nature. Additionally, in tumors of the bod y of the pancreas, hand-assisted laparoscopic distal pancreatectomy might h ave the advantages of laparotomy and laparoscopy in terms of handling the s plenic artery and vein just below the minilaparotomy site: suggesting an ea sier and safer procedure than complete laparoscopic distal pancreatectomy. Therefore, hand-assisted laparoscopic distal pancreatectomy can be recommen ded as a useful alternative to complete laparoscopic distal pancreatectomy for selected patients with benign tumors of the body and tail of the pancre as.