Though technically feasible, this procedure is not frequently performed, probably due to the limited cases selleck kinase inhibitor indicated for this procedure, the technical difficulty involved, and the high-tech devices required. Today indications for distal pancreatectomy include distal tumors (neuroendocrine and cystic lesions), chronic pancreatitis, and isolated pseudocysts. In the past 10 years, minimal access surgery is increasingly popular and is moving towards further minimizing the surgical trauma by reducing numbers and size of the port. In the last few years, a novel technique called ��Scar-less surgery�� through a single-incision laparoscopic approach, has become one of the emerging technique. This technique is becoming popular especially for female patients due to the invaluable cosmetic results.

In our institution, surgery using single port technique, such as appendicectomy, cholecystectomy, and hernia repair, is widely under investigation by randomized control trials. More complex operations with single-port technique are also being performed involving obesity surgeries, gastrectomies, liver resections, and so forth. Distal pancreatectomy may be another promising procedure that can be done through single-incision approach due to the wide range of instruments, energy sealing devices, and staplers available today. This report will present our initial experience with spleen preserving distal pancreatectomy technique through a small transumbilical incision using the single-port approach. 2. Case Report A 40-year-old female was found to have a 3.

5cm cyst at the body of the pancreas on ultrasound during a routine health screening. She had 2 previous laparoscopic procedures for pelvic inflammatory disease and excision of ovarian cyst. A CT scan showed a complex cyst with septations measuring more than 3cm and subsequent endoscopic ultrasound followed with fine-needle aspiration showed a multiloculated hypoechoic cystic lesion located at the body of pancreas with high Ca 19-9 of 148.2U/mL (n.v. �� 37U/mL), (Figure 1), suggestive of cystic mucin-producing neoplasm. She subsequently underwent spleen-preserving distal pancreatectomy via single-port approach. Figure 1 Endoscopic ultrasound image showing the cyst in pancreatic body. 3. Surgical Technique Under general anesthesia, patient was placed in a French position with both arms tucked in.

An SILS (Covidien USA) port was introduced through a 2cm midline periumbilical incision, and three 5mm ports AV-951 were introduced into the SILS port. Pneumoperitoneum was achieved, with pressure setting of 13mmHg. A diagnostic laparoscopy was performed, using the 5mm Endo-eye (Olympus, Japan) 30�� telescope to confirm the absence of advance malignant disease. Out of the standard instrumentation, an Endograsp roticulator (Covidien AutoSuture, USA) was utilized during the surgery to avoid clashes and conflict between instruments and telescope and to improve triangulation.