Two patients with cystic
tumors of the pancreas treated by laparoscopic distal
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 complete laparoscopic distal
pancreatectomy. After mobilization of the distal pancreas and spleen, the pancreas was transected proximally together with the splenic artery and vein using an endoscopic linear stapler. The second patient was a 71-year-old woman with a 6-cm
cystadenoma of the body of the pancreas, treated by hand-assisted laparoscopic distal
pancreatectomy with
minilaparotomy because the
tumor was adjacent to the portal vein and celiac axis. Using an upper median
minilaparotomy, dissection of the gastrocolic ligament, division of the splenic artery, and transection and closure of the pancreas 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 fistulas) in either patient, and the postoperative courses were uneventful. The patients returned to normal activity within 1 week after the operation. Complete laparoscopic and hand-assisted laparoscopic distal
pancreatectomy are preferable to conventional open surgery for benign
tumors of the pancreas because of their less-invasive nature. Additionally, in
tumors of the body of the pancreas, hand-assisted laparoscopic distal
pancreatectomy might have the advantages of
laparotomy and laparoscopy in terms of handling the splenic artery and vein just below the
minilaparotomy site, suggesting an easier and safer procedure than complete laparoscopic distal
pancreatectomy. Therefore, hand-assisted laparoscopic distal
pancreatectomy can be recommended as a useful alternative to complete laparoscopic distal
pancreatectomy for selected patients with benign
tumors of the body and tail of the pancreas.