Two cases of laparoscopic spleen preserving distal pancreatectomy for pancreatic insulinoma with preservation of the splenic vessels utilizing two different approaches

Abstract

An 80-year-old woman and a 67-year-old woman consulted our hospital with recurrent attacks of hypoglycemia. The findings of biochemical and radiological examinations and selective arterial calcium injection test (SACI) resulted in the diagnosis of a solitary insulinoma of the pancreatic body and tail. Laparoscopic spleen preserving distal pancreatectomy (LSPDP) with preservation of the splenic vessels was performed for both cases. Each postoperative course was uneventful except for a Grade B-pancreatic fistula that occurred in the 80-years-old female. LSPDP with preservation of the splenic vessels has required advanced laparoscopic techniques and has not become a common operative procedure yet. However, it could be performed safely and used as an adequate laparoscopic approach to the splenic vessels. This practice could become one of the standard procedures for partial pancreatic resection.