Laparoscopic Distal Pancreatectomy with Spleen Preservation | Advanced HPB Surgery

Introduction

The pancreas plays a vital role in digestion and blood sugar regulation, and diseases affecting this organ require highly specialized care. One of the safest and most effective procedures for pancreatic tail and body lesions is the Laparoscopic Distal Pancreatectomy with Spleen Preservation — a minimally invasive surgery that removes the diseased portion of the pancreas while preserving the spleen and its important immune functions.

At PACE Hospitals Hyderabad, our HPB (Hepato-Pancreato-Biliary) and GI surgical team offers this advanced procedure using 3D laparoscopy and precision instruments, ensuring faster recovery, minimal scarring, and excellent long-term outcomes for both benign and early malignant pancreatic diseases.

What Is a Laparoscopic Distal Pancreatectomy?

A distal pancreatectomy involves surgical removal of the left (distal) portion of the pancreas, typically involving the body and tail. When performed laparoscopically, the surgeon uses small keyhole incisions and a high-definition camera to access and remove the diseased part, ensuring minimal trauma to surrounding tissues.

In spleen-preserving distal pancreatectomy, the surgeon carefully preserves the splenic artery and vein (Warshaw or Kimura technique), maintaining spleen viability and immune function.

Why Preserve the Spleen?

The spleen is an essential organ for immunity, helping the body fight bacterial infections and filter abnormal blood cells. Removing it (splenectomy) may increase the risk of life-threatening infections, especially in young or immunocompromised patients.

Thus, whenever possible, spleen-preserving surgery is preferred, especially for:

• Benign pancreatic cysts or tumors (e.g., mucinous cystadenoma, serous cystadenoma)
• Low-grade malignant lesions
• Neuroendocrine tumors
• Chronic pancreatitis involving the distal pancreas
  

Indications for Laparoscopic Distal Pancreatectomy

PACE Hospitals’ surgical experts recommend this procedure in the following conditions:

• Pancreatic cystic neoplasms (mucinous cystadenoma, serous cystadenoma)
• Pancreatic neuroendocrine tumors
• Solid pseudopapillary tumor of the pancreas
• Chronic pancreatitis localized to body/tail
• Intraductal papillary mucinous neoplasms (IPMN)
• Pancreatic trauma or injury
• Benign or low-grade malignant lesions of the distal pancreas

For malignant tumors with vascular or lymphatic involvement, a distal pancreatectomy with splenectomy may still be required.

Preoperative Evaluation at PACE Hospitals

Before surgery, every patient undergoes a detailed assessment by the HPB surgical and gastroenterology teams to determine operability and optimize outcomes.

Diagnostic Tests May Include:

• Contrast-enhanced CT or MRI of the abdomen
• Endoscopic Ultrasound (EUS) with biopsy
• PET-CT (for tumor staging if required)
• Liver and kidney function tests
• Tumor markers (CA 19-9, CEA)
• Cardiac and anesthetic evaluation

Patients are also counseled on the nature of the surgery, expected recovery, and the benefits of spleen preservation.

The Laparoscopic Surgical Procedure

Step-by-Step Overview:

• Anesthesia and Positioning: The patient is placed under general anesthesia and positioned in a slight left lateral decubitus position to optimize exposure.
• Port Placement: Several small incisions (5–10 mm) are made for laparoscopic ports through which instruments and a camera are inserted.
• Mobilization of the Pancreas: The surgeon gently separates the pancreas from surrounding tissues and the splenic vessels using energy devices.
• Identification of Splenic Vessels: In spleen-preserving techniques, splenic artery and vein are meticulously dissected and preserved (Kimura technique). Alternatively, in the Warshaw technique, short gastric vessels maintain splenic blood flow when main splenic vessels are divided.
• Division of the Pancreas: The distal pancreas is divided using a laparoscopic stapler, ensuring hemostasis and sealing of the pancreatic duct.
• Specimen Retrieval: The resected portion is placed in a retrieval bag and removed through a small incision.
• Drain Placement: A surgical drain may be placed near the pancreas to monitor for postoperative leakage.
• Closure: Small incisions are closed using absorbable sutures, leaving minimal scarring.
  

Postoperative Recovery and Care

At PACE Hospitals, postoperative care focuses on early mobilization, pain control, and nutritional recovery.

• Hospital Stay: Typically 3–5 days
• Oral intake: Resumed within 1–2 days post-surgery
• Drain removal: Usually after 3–5 days once output is minimal
• Return to work: Within 2–3 weeks

Recovery Benefits of Laparoscopic Surgery:

• Smaller incisions and minimal scarring
• Reduced postoperative pain
• Faster discharge
• Lower risk of infection
• Better cosmetic results

With modern equipment, advanced energy devices, and intraoperative imaging, such complications are minimized at PACE Hospitals.