Laparoskopische milzerhaltende Pankreaslinksresektion (Warshaw)

Zusammenfassung

Zielsetzung

Der Videobeitrag soll strukturiert durch die laparoskopische Pankreaslinksresektion in der Warshaw-Technik führen.

Indikationen

Die laparoskopische Pankreaslinksresektion mit Milzerhalt gilt bei benignen oder niedrig malignen Tumoren als etablierter Standard und kann mit oder ohne Durchtrennung der Milzgefäße erfolgen. Während im Allgemeinen ein Erhalt der Milzgefäße empfohlen wird, kommt in ausgewählten Fällen auch die Technik nach Warshaw infrage, bei der die Milzgefäße regelhaft durchtrennt werden.

Methode

In diesem Videobeitrag wird das operative Vorgehen bei einer 84-jährigen Patientin mit einer zystischen Raumforderung im Pankreasschwanz gezeigt. Die zentralen Keypoints der Operation werden demonstriert.

Schlussfolgerung

Die milzerhaltende laparoskopische Pankreaslinksresektion mit Durchtrennung der Milzgefäße ist ein etabliertes Verfahren, das hoch standardisiert durchgeführt werden kann.

Abstract

Aim

The video vignette will provide a structured guide to laparoscopic distal pancreatectomy using the Warshaw technique.

Indications

Spleen-preserving laparoscopic distal pancreatectomy is considered the established standard for benign or low-grade malignant tumours and can be performed with or without preservation of the splenic vessels. Preservation of the splenic vessels is generally recommended, but the Warshaw technique, which involves routine division of the splenic vessels, is an option in selected cases.

Methods

This video demonstrates the surgical procedure on an 84-year-old patient with a cystic lesion in the pancreatic tail. The central key points of the operation are demonstrated.

Conclusion

Spleen-preserving laparoscopic distal pancreatectomy with division of the splenic vessels is an established procedure that can be performed in a highly standardised manner.

Schlüsselwörter

Pankreaschirurgie - Linksresektion - laparoskopische Chirurgie

Keywords

laparoscopic surgery - pancreatic surgery - distal pancreatectomy

Publikationsverlauf

Eingereicht: 30. Juni 2025

Angenommen nach Revision: 24. September 2025

Artikel online veröffentlicht:
03. November 2025

• Literatur

• 1 Zhun Hong Wong N, Wei Ting Yap D, Lei Ng S. et al. Oncological outcomes in minimally invasive vs. open distal pancreatectomy: a systematic review and network meta-analysis. Front Surg 2024; 11: 1369169
• 2 Hajibandeh S, Ghassemi N, Hajibandeh S. et al. Meta-analysis of laparoscopic spleen-preserving distal pancreatectomy versus laparoscopic distal pancreatectomy with splenectomy: An insight into confounding by indication. Surgeon 2024; 22: e13-e25
• 3 Casciani F, Trudeau MT, Vollmer CM. Perioperative Immunization for Splenectomy and the Surgeon’s Responsibility: A Review. JAMA Surg 2020; 155: 1068-1077
• 4 Warshaw AL. Conservation of the spleen with distal pancreatectomy. Arch Surg 1988; 123: 550-553
• 5 Granieri S, Bonomi A, Frassini S. et al. Kimura’s vs Warshaw’s technique for spleen preserving distal pancreatectomy: a systematic review and meta-analysis of high-quality studies. HPB (Oxford) 2023; 25: 614-624
• 6 Fonseca AL, Kirkwood K, Kim MP. et al. Intraductal Papillary Mucinous Neoplasms of the Pancreas: Current Understanding and Future Directions for Stratification of Malignancy Risk. Pancreas 2018; 47: 272-279
• 7 Türkoğlu A, Oğuz A, Yaman G. et al. Laparoscopic splenectomy: clip ligation or en-bloc stapling?. Turk J Surg 2019; 35: 273-277
• 8 Huang KC, Lin WR, Chen M. et al. Does the stapler for en bloc resection of renal pedicles during kidney removal surgery increase the risk of arteriovenous fistula?. J Chin Med Assoc 2019; 82: 221-224
• 9 Schatloff O, Ramon J, Lindner U. et al. Is postoperative arteriovenous fistula still a concern after en bloc stapling of the renal hilum during laparoscopic nephrectomy?. J Endourol 2009; 23: 639-643
• 10 Schatloff O, Lindner U, Lindner A. Current status of en bloc stapling of the renal hilum during laparoscopic nephrectomy. J Laparoendosc Adv Surg Tech A 2010; 20: 631-633
• 11 Vargün R, Göllü G, Fitöz S. et al. En-bloc stapling of the splenic hilum in laparoscopic splenectomy. Minim Invasive Ther Allied Technol 2007; 16: 360-362
• 12 Probst P, Hüttner FJ, Klaiber U. et al. Stapler versus scalpel resection followed by handsewn closure of the pancreatic remnant for distal pancreatectomy. Cochrane Database Syst Rev 2025; 6: CD008688
• 13 Sepesi B, Moalem J, Galka E. et al. The influence of staple size on fistula formation following distal pancreatectomy. J Gastrointest Surg 2012; 16: 267-274
• 14 Elkomos BE, Elkomos PE, Salem AA. et al. The outcome of bioabsorbable staple line reinforcement versus standard stapler for distal pancreatectomy: A systematic review and meta- analysis. J Minim Access Surg 2022; 18: 338-345
• 15 Guzman EA, Nelson RA, Kim J. et al. Increased incidence of pancreatic fistulas after the introduction of a bioabsorbable staple line reinforcement in distal pancreatic resections. Am Surg 2009; 75: 954-957
• 16 Yamamoto M, Hayashi MS, Nguyen NT. et al. Use of Seamguard to prevent pancreatic leak following distal pancreatectomy. Arch Surg 2009; 144: 894-899
• 17 Uranues S, Fingerhut A, Belyaev O. et al. Clinical Impact of Stump Closure Reinforced With Hemopatch on the Prevention of Clinically Relevant Pancreatic Fistula After Distal Pancreatectomy: A Multicenter Randomized Trial. Ann Surg Open 2021; 2: e033
• 18 Bubis LD, Behman R, Roke R. et al. PATCH-DP: a single-arm phase II trial of intra-operative application of HEMOPATCHTM to the pancreatic stump to prevent post-operative pancreatic fistula following distal pancreatectomy. HPB (Oxford) 2022; 24: 72-78
• 19 Walber JK, Antony P, Strothmann H. et al. Effect of artificial or autologous coverage of the pancreatic remnant or anastomosis on postoperative pancreatic fistulas after partial pancreatectomy: meta-analysis of randomized clinical trials. BJS Open 2024; 8: zrae059
• 20 Klaiber U, Collins PM, Trinkler S. et al. A systematic review and meta-analysis of morbidity and pancreatic fistula after distal pancreatectomy with versus without prophylactic intra-abdominal drainage. Int J Surg 2024; 110: 7215-7224
• 21 van Bodegraven EA, Balduzzi A, van Ramshorst TME. et al. Prophylactic abdominal drainage after distal pancreatectomy (PANDORINA): an international, multicentre, open-label, randomised controlled, non-inferiority trial. Lancet Gastroenterol Hepatol 2024; 9: 438-447
• 22 Siech M, Strauss P, Huschitt S. et al. The Indications for Laparoscopic Pancreatectomy. Dtsch Arztebl Int 2017; 114: 263-268