Background : Laparoscopic distal pancreatectomy (LDP) is the gold standard procedure nowadays for the treatment of symptomatic benign, premalignant and malignant pancreatic body and tail lesions. However, in some patients the procedure remains technically demanding. In such cases the most easily accessible major landmark is the common hepatic artery (CHA). Herein we present our experience with LDP, demonstrate our technical approach and describe steps to facilitate the access of the SA.

Methods : From 01.10.2018 to 01.10.2023, 25 patients underwent LDP in the First Clinic of Abdominal Surgery, Military Medical Academy – Sofia, Bulgaria. Demographic characteristics, pathological data, intraoperative conditions, postoperative complications and other clinical data of patients with benign, borderline or malignant tumors of pancreatic tail and body was included and analyzed prospectively in the study.

Results : In 40% of the minimally-invasive cases, we used the CHA approach (CHAA) (n=10). Mean operative time was 180 minutes for standard laparoscopic distal pancreatectomy (SLDP) and laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and 183 minutes for the CHAA. Median estimated blood loss and length of hospital stay was 207, 108 and 140 ml and 7, 8 and 7 days for patients with SLDP, LSPDP and CHAA. Overall morbidity rate was 20%, 4% and 0% respectively. Postoperative mortality was 4% (n=1) in the SLDP group and 0% in the LSPDP and CHAA groups. Median overall survival was 53, 55 and 54 months respectively.

Conclusions : Laparoscopic distal pancreatectomy can sometimes be technically demanding and identification of common hepatic artery can guide surgeons for safety performance.