Treatment of Middle-segment Pancreatic Benign Tumor Using Laparoscopic Central Pancreatectomy with End-to-end Pancreatic Duct Reconstruction

To begin, explore abdominal organs to assess the intraabdominal condition and to ensure no obvious ascites was present. Observe a distended gallbladder with no significant wall thickening. Open the gastrocolic ligament using an ultrasonic dissector.

Divide the left half of the ligament segmentally up to the avascular plane, and continue the dissection to the right as far as the pancreatic head. Fully expose the non-ididymis and soft pancreas. Then identify a mass located at the pancreatic neck and body.

Observe multiple 0.3-centimeter-by-0.3-centimeter cysts to the right of the mass and a larger single cyst superior and to the left. To perform the mid-segment pancreatic resection, first open the lesser mentum. Retract the stomach and liver to fully expose the pancreas.

Mobilize the inferior border of the mid-pancreas. Identify the superior mesenteric vein and the root of the splenic vein. Proceed with dissection leftward along the posterior-inferior aspect of the pancreas, toward the left margin of the lesion.

Then dissect the superior border to expose the common hepatic artery. Transect the pancreatic neck just to the right of the mass using the ultrasonic dissector. Sharply divide the pancreatic duct with scissors, noting the clear pancreatic fluid.

Complete the transection of the remaining pancreatic tissue and achieve hemostasis by coagulating the cut surface. Now, free the superior pancreatic vessels. Isolate the splenic artery and carefully dissect the posterior aspect of the pancreatic body and the superior border along the splenic artery and vein.

Clip and divide all vessels entering the pancreas, then continue the dissection to the left margin of the lesion. Transect the pancreas to the left of the mass using the ultrasonic dissector. Sharply divide the pancreatic duct, again observing clear pancreatic fluid.

Then divide the remaining pancreatic tissue and coagulate the cut surface for final hemostasis. Place the resected mid-segment of the pancreas into a specimen retrieval bag and retrieve. Extend the umbilical incision approximately three centimeters toward the umbilicus to deliver the specimen.

Upon receiving the pathology report stating pancreatic lesion favor benign tumor, proceed with the planned LCP and end-to-end pancreatic duct reconstruction. Approximate the superior pancreatic margins with 3-O Prolene figure-of-eight sutures. Trim a 24-gauge scalp needle sheath to an 11-centimeter stent and insert it into the pancreatic duct.

Secure the duct at the six, nine, 12 and three o'clock positions using 4-0 Prolene figure-of-eight stitches. Place three additional 3-0 Prolene figure-of-eight sutures to complete the end-to-end pancreatic anastomosis. Then flush the peritoneal cavity with normal saline and aspirate until dry.

Introduce a 24 French silicone drain through the left abdominal wall and position it above the pancreas. Place another identical drain through the right port, positioning it below the pancreatic remnant before closing incisions. The final pathological diagnosis was confirmed as a microcystic variant of serous cyst adenoma.

The postoperative computed tomography scan demonstrated uniform pancreatic parenchymal density without surrounding exudative changes, and confirmed satisfactory positioning of the pancreatic duct stent.