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| “Parenchyma transection-first”strategy is superior to “tunnel-first”strategy in robotic spleen-preserving distal pancreatectomy with conservation of splenic vessels |
| Meng-Yang Li a , # , Hao-Zhe Cui a , b , # , Jia-Ning Hao a , # , Da-Bin Xu a , En-Li Zhang a , Zhu-Zeng Yin a , Zhi-Ming Zhao a , ∗ |
a Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
b School of Medicine, Nankai University, Tianjin 300071, China
∗Corresponding author. E-mail address: Zhimingzhao616@126.com (Z.-M. Zhao).
# Contributed equally. |
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Abstract Background: Creating a tunnel between the pancreas and splenic vessels followed by pancreatic parenchyma transection (“tunnel-first”strategy) has long been used in spleen-preserving distal pancre- atectomy (SPDP) with splenic vessel preservation (Kimura’s procedure). However, the operation space is limited in the tunnel, leading to the risks of bleeding and difficulties in suturing. We adopted the pan- creatic “parenchyma transection-first”strategy to optimize Kimura’s procedure.
Methods: The clinical data of consecutive patients who underwent robotic SPDP with Kimura’s procedure between January 2017 and September 2022 at our center were retrieved. The cohort was classified into a “parenchyma transection-first”strategy (P-F) group and a “tunnel-first”strategy (T-F) group and analyzed.
Results: A total of 91 patients were enrolled in this cohort, with 49 in the T-F group and 42 in the P-F group. Compared with the T-F group, the P-F group had significantly shorter operative time (146.1 ±39.2 min vs. 174.9 ±46.6 min, P < 0.01) and lower estimated blood loss [40.0 (20.0–55.0) mL vs. 50.0 (20.0–100.0) mL, P = 0.03]. Failure of splenic vessel preservation occurred in 10.2% patients in the T- F group and 2.4% in the P-F group ( P = 0.14). The grade 3/4 complications were similar between the two groups ( P = 0.57). No differences in postoperative pancreatic fistula, abdominal infection or hemorrhage were observed between the two groups.
Conclusions: The pancreatic “parenchyma transection-first”strategy is safe and feasible compared with traditional “tunnel-first strategy”in SPDP with Kimura’s procedure.
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2023, Vol. 22 
