Laparoscopic Distal Pancreatectomy with or without Preservation of the Spleen for Solid Pseudopapillary Neoplasm

Figure 9

(a) Excess countertraction by the forceps and tape (yellow arrows) resulted in unexpected injury to the pancreatic parenchyma and capsule (red circles). Excess traction on the tape was released (red arrow). (b) Excess countertraction during stapling (yellow arrows) caused capsular injury near the staple line. Stapling should be performed as much to the dorsal side as possible to reduce excess countertraction (red arrow). A powered stapling system attenuates excess countertraction. (c) Excess tension when withdrawing during the stapler bite (yellow arrows) causes injury to the pancreatic parenchyma and membrane. All stapling procedures should be done at the correct position on the pancreas (red arrows). (d) Subtle injury to the capsule (red circle) should be never missed when evaluating the safety of pancreas resection.

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