Brief Article
Copyright ©2012 Baishideng Publishing Group Co.
World J Gastroenterol. Apr 28, 2012; 18(16): 1959-1967
Published online Apr 28, 2012. doi: 10.3748/wjg.v18.i16.1959
Table 1 Database and search strategy
DatabaseSearch strategy
PubMed"laparoscopy" (MeSH terms) or "laparoscopy" (all fields) or "laparoscopic" (all fields) or (minimally (all fields) and invasive (all fields) and ("pancreas" (MeSH terms) or "pancreas" (all fields) or "pancreatic" (all fields) and "humans" (MeSH terms) and English (lang) and "1995/1/1" (PDAT): "2011/06/30" (PDAT)
Web of Science"pancreas" or "pancreatic" or "pancreatectomy" and "laparoscopy" or "laparoscopic" (limited year: 1995-2011)
Cochrane Library"pancreas" or "pancreatic" or "pancreatectomy" and "laparoscopy" or "laparoscopic" (limited year: 1995-2011)
BIOSIS Previews"pancreas" or "pancreatic" or "pancreatectomy" and "laparoscopy" or "laparoscopic" (limited year: 1995-2011) (related term and limited English and human and year: 1995-2011)
Table 2 Characteristics of the literatures
Ref.Study yearNationCase number
Study typePancreatictransection
Spleen persevation
Mortality %
Level of evidence
Aly et al[23]1998-2009Japan4035RetroStaplerStapler/scalpel + suture13381156004
Baker et al[24]2003-2008USA2785ProsStapler/ scalpel + micro sealer deviceScalpel + sutureNA1030612002b
Butturini et al[25]1999-2006Italy4373RetroStaplerScalpel + suture19821331210002b
Casadei et al[26]2000-2010Italy2222Case controlStaplerStaplerNA6624002b
DiNorcia et al[27]1991-2009USA71192RetroStaplerStapler/ Scalpel + suture11302084827024
Eom et al[28]1995-2006Korea3162RetroStaplerScalpel + suture13NA111534004
Jayaraman et al[29]2003-2009USA74236RetroStapler/ scalpel + sutureStapler/ scalpel + suture14331194631NA4
Kim et al[30]NAKorea9335RetroStaplerStapler/ Scalpel + suture382231185NA4
Vijan et al[31]2004-2009USA100100RetroStaplerNA25NA34291717314
Table 3 Technical details of spleen-preservation
Ref.Spleen preserving %
Technical details
Aly et al[23]32.58.6Both procedures, spleen vessel ligation were performed, leaving the short gastric vessels to supply the spleen (Warshaw)
Baker et al[24]NAIn ODP, the benign and premalignant pathology, the spleen was routinely saved by means of the splenic vein and artery preserved
In LDP, splenic salvage by means of Warshaw: ligating the splenic artery and vein but preserve the short gastric vessel
Butturini et al[25]44.211.0Both procedures, exposing the splenic vein up to the splenic hilum; the distal pancreas was detached from the splenic artery in the opposite direction by tractioning the parenchyma
Casadei et al[26]NAMobilization of the distal pancreas from retroperitoneum and splenic vessels
DiNorcia et al[27]15.515.6For spleen preserving distal pancreatectomy, an attempt to spare the splenic artery and vein was made in all patients
Eom et al[28]41.9NAFor spleen preserving distal pancreatectomy, both the splenic artery and vein were preserved
Jayaraman et al[29]18.914.0When splenic preservation was performed, the splenic vein and artery were isolated
Kim et al[30]40.95.70In spleen preserving distal pancreatectomy, both the splenic artery and vein were preserved. In one case, the splenic artery was ligated with preservation of splenic vein. In the other case, both the splenic artery and vein were ligated, with preservation of short gastric vessels (Warshaw)
Vijan et al[31]25NAIf splenic preservation is indicated, the pancreas is dissected off the splenic vessels
Table 4 Technique of pancreatic stump closure
Ref.Technique description
Aly et al[23]LDPThe pancreatic parenchyma was transected using a laparoscopic linear stapler
ODPThe pancreatic parenchyma was transected using a scalpel, and the main pancreatic duct was ligated using nonabsorbable sutures. The pancreatic stump was closed with fish-mouth sutures. A linear stapler was used to transect the pancreatic parenchyma
Baker et al[24]LDPThe gland was divided by one of 3 mechanisms: vascular stapler, harmonic scalpel, or harmonic scalpel following ablation at the pancreatic resection margin with the Habib 4*3 microsealer device
ODPDirectly ligate the pancreatic duct when visible with a monofilament absorbable suture. The neck of the gland was oversewn with nonabsorbable monofilament suture
Butturini et al[25]LDPThe pancreatic body was transected by a linear endostapler
ODPPancreatic parenchyma was sharply transected. The main pancreatic duct was closed with nonabsorbable sutures (polypropylene 4/0). Subsequently the pancreatic stump was oversewn with interrupted mattress nonabsorbable sutures or closed using a linear stapler
Casadei et al[26]LDPThe pancreas was divided at the neck using an endo-GIA instrument
ODPThe pancreas was divided using GIA 55
DiNorcia et al[27]LDPSutures, staples, sutures and staples combined, or staples with bioabsorbable staple-line reinforcement
Eom et al[28]LDPThe pancreas was transected using the 48- or 35-mm vascular endoscopic linear stapler
ODPThe pancreatic parenchyma was divided using a blade and electrocautery. The main pancreatic duct was ligated with nonabsorbable sutures, and the transected pancreas was occluded with interlocking interrupted mattress sutures of 4-0 black silk and reinforced with 4-0 polypropylene
Jayaraman et al[29]LDPThe pancreas was stapled using a vascular stapler with or without a Seamguard attachment
ODPLigate pancreas with staples, or via suture ligation, or a combination of techniques
Kim et al[30]LDPFor pancreatic transaction, straight endoscopic linear staplers of various sizes (staple height, 3.5-4.2 mm) were used according to the thickness or hardness of the pancreas. Four or five small titanium clips were applied along the stapling line
ODPThe pancreatic stump underwent main duct ligation, multiple suture ligation of the branch duct exposed at the resection margin, and reinforcement of the mattress suture to the pancreas stump
Vijan et al[31]LDPThe pancreatic parenchyma is divided with the harmonic scalpel (preferred) or with an Endo GIA stapler