PMC9475139_01
A: Magnetic resonance imaging. B: Magnetic resonance cholangiopancreatography..
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F1
Preoperative design. A: Layout of "5 trocar-puncture". B: LCP-removal procedure. C: Schematic diagram of CP pancreatic margin.
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F2
Artificial pneumoperitoneum was established by using the layout of "5 trocar-puncture" (Figure 2A). The middle pancreas and the main pancreatic duct were cut off from the left and right sides of the tumor with an ultrasonic knife when the cutting lines were marked by suturing a traction line on the "A" and "B" tangent plane (Figure 2C). The routinely intraoperative frozen pathology of the removal specimen showed that the pancreatic tumor belonged to the benign lesions and no tumor or tissue infiltration of the high-grade atypia hyperplasia (HGD) was observed at the trans-section margins of the pancreatic parenchyma and duct.
Pancreatic reconstruction process.
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F3
The second was the pancreatic reconstruction process (Figure 3): Due to the significantly dilated pancreatic duct and thin pancreatic tissue, in this case, the end-to-end pancreatic anastomosis could be performed analogous to an intestinal anastomosis.
Laparoscopic central pancreatectomy (involving A, B, C, D four steps).
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F4
The posterior walls of the pancreas and pancreatic duct of the two ends that might be considered the posterior layer of the intestinal anastomosis were continuously sutured with a 4-0 prolene line (Figure 4A). Similarly, the anterior wall of the pancreas and pancreatic duct of the two ends that might also be considered the anterior layer of the intestinal anastomosis was repaired by interrupted 4.0 prolene sutures (Figure 4B). One end of this tube was placed in the remanent pancreas and the other end was placed through the duodenal papilla into the duodenum (Figures 4C,D).
The pigtail position.
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F5
To avoid stent-tube displacement, one end of the stent tube was sutured and fixed at the end-to-end anastomosis of the pancreas and the curled end would catch the duodenal papilla when the inner core of the stent tube was taken out (Figure 5).
Postoperative outcome: CT and pathological images. A: CT images, B: pathological images.
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F6
Postoperative pathological images (Figure 6B) showed that the lesion tissue matched the preoperative imaging diagnosis of IPMN.
Postoperative outcome: the amylase (A) and volume of abdominal drainage tubes (B).
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F7
On POD1, 3, 5, and 7, the ascitic amylase (Figure 7A) and the volume (Figure 7B) of the two abdominal drainage tubes and the blood results such as C reactive protein (CRP), white blood cell (WBC) count, procalcitonin (PCT), hemoglobin (HGB), and serum amylase (AMS) were tested (Tables 1, 2).