Procedure in Distal Pancreatectomy Surgery

Introduction

Distal pancreatectomy is a surgical procedure performed to remove the body and tail of the pancreas, usually due to tumors, cysts, chronic pancreatitis, or trauma. This surgery is often indicated when abnormalities are localized in the left portion (distal part) of the pancreas. In many cases, the spleen is also removed due to its close anatomical relationship with the tail of the pancreas.

The procedure in distal pancreatectomy surgery can be performed using various techniques open surgery, laparoscopic surgery, or robot-assisted methods. Regardless of the approach, the underlying surgical steps follow a common pattern, aimed at safe and effective removal of the diseased pancreatic tissue. The procedure demands high surgical precision because the pancreas lies deep in the abdominal cavity and is closely associated with critical blood vessels and organs.

Understanding the procedure in distal pancreatectomy Surgery and how does it helps patients prepare mentally and physically for the surgery. It also allows caregivers to provide better support throughout the surgical journey. Below are the main steps involved in the procedure, presented with clarity and depth.

Procedure in Distal Pancreatectomy Surgery

1. Preoperative Evaluation and Planning :- Before the surgery, a comprehensive assessment is conducted to determine the patient’s fitness and the exact nature of the pancreatic condition. This includes imaging tests like CT scan, MRI, or endoscopic ultrasound to locate the lesion and understand its relation to surrounding structures. Blood tests are performed to evaluate liver and kidney function, complete blood count, and coagulation profile. In cases of suspected cancer, tumor markers like CA 19-9 may be measured. The anesthesia team also evaluates the patient to ensure they are fit for general anesthesia. Detailed planning helps the surgical team decide on the appropriate surgical approach open, laparoscopic, or robotic.

2. Administration of General Anesthesia :- The patient is brought to the operating room and placed under general anesthesia, ensuring they are unconscious and pain-free during the procedure. A breathing tube is inserted to maintain airway control, and intravenous (IV) lines and monitoring devices are attached to track vital signs. In some cases, a central venous catheter or arterial line may be placed to monitor blood pressure and administer medications more efficiently during complex surgeries. The patient is then positioned usually in a supine position with arms extended to allow maximum access to the abdominal cavity.

3. Abdominal Access and Port Placement :- In an open procedure, a long incision is made along the midline or upper abdomen to expose the pancreas. For laparoscopic or robotic surgery, small incisions are made for the insertion of ports. These ports serve as entry points for a camera and specialized instruments. Carbon dioxide gas is used to inflate the abdomen, creating working space for the surgical instruments. The surgeon then uses a high-definition camera to visualize the abdominal contents on a monitor. In robotic procedures, the surgeon operates from a console, controlling robotic arms with precision.

4. Exposure and Mobilization of the Pancreas :- The surgeon begins by carefully moving aside nearby organs such as the stomach and intestines to access the pancreas. The pancreas lies behind the stomach and in front of major blood vessels, so gentle and precise dissection is necessary. The body and tail of the pancreas are identified, and the surgeon separates them from surrounding tissues. This includes division of the peritoneal attachments and gentle retraction of the splenic flexure of the colon. In cases where the spleen is to be preserved, the splenic artery and vein are carefully dissected away from the pancreatic tissue.

5. Ligation of Blood Vessels :- Once the pancreas is exposed, blood vessels supplying the distal portion need to be securely ligated (tied off) to prevent bleeding. The splenic artery and splenic vein major vessels associated with the tail of the pancreas and the spleen are identified and carefully sealed or tied off. If the spleen is being preserved, the vessels are maintained or re-routed using techniques such as the Warshaw method, which relies on the short gastric vessels to supply the spleen. Meticulous hemostasis (control of bleeding) is critical at this stage to prevent postoperative complications.

6. Division of the Pancreas :- The body of the pancreas is then divided using a surgical stapler or a scalpel, depending on the surgeon’s preference. In most cases, the cut surface is reinforced with sutures or sealants to reduce the risk of pancreatic fluid leakage. This is a sensitive part of the surgery because the pancreas produces digestive enzymes, and any leak can lead to inflammation or abscess formation. Various techniques and materials, such as fibrin glue or tissue patches, may be used to reinforce the closure and reduce the risk of postoperative pancreatic fistula.

7. Removal of the Pancreatic Tissue :- After the pancreas is divided, the tail and body along with the spleen if necessary are gently removed from the abdominal cavity. The specimen is placed in a protective bag and extracted through one of the incisions. In laparoscopic or robotic cases, a small incision may be enlarged temporarily to allow removal of the specimen. The tissue is then sent to pathology for detailed examination, including margin status and disease type. If cancer is present, lymph nodes are also removed for staging purposes.

8. Drain Placement and Irrigation :- After removal of the tissue, the surgical site is thoroughly irrigated with sterile fluid to reduce the risk of infection. A surgical drain may be placed near the cut surface of the pancreas to monitor for leaks of pancreatic fluid or blood. The decision to place a drain varies by surgeon and institution. In some cases, particularly when the surgery is straightforward and the risk of leakage is low, no drain is used. The drain, if placed, typically remains in place for a few days after surgery and is removed based on the amount and content of the drainage.

9. Closure of Incisions :- Once hemostasis is confirmed and all necessary structures are secured, the incisions are closed. In open surgery, the abdominal wall is closed in layers using sutures. In minimally invasive surgery, the small port incisions are closed with absorbable sutures or surgical glue. A sterile dressing is applied, and the patient is awakened from anesthesia and transferred to the recovery room. Pain management is initiated, and postoperative care begins immediately with close monitoring of vital signs, fluid status, and drainage.

Conclusion

Distal pancreatectomy is a complex but potentially life-saving procedure for patients with localized pancreatic disease. With advances in surgical techniques, the procedure has become safer, with shorter recovery times and better outcomes. The key to success lies in meticulous preoperative planning, surgical precision, and effective postoperative care.

Whether performed through open, laparoscopic, or robotic approaches, each step of the procedure is aimed at safely removing the diseased portion of the pancreas while preserving surrounding structures. By understanding the process, patients are better prepared to navigate the journey of pancreatic surgery with confidence and clarity.