LAPAROSCOPIC DISTALPANCREATECTOMY FOR TREATMENTOF INSULINOMA IN DOGS: AN INNOVATIVE FLANK APPROACH

Objective: Description and feasibility of a flank approachin sternal recumbence for laparoscopic distal pancreatec-tomy for insulinoma.Methods: Pancreatic anatomy in sterna l position wasstudied in a cadaver. Three dogs (Jack Russel, Dachshund,German Shepherd) diagnosed with a 1-1.5 cm pancreaticlimb insulinoma (2 left, 1 right) without evidence of metas-tasis on triple-phase contrast-CT were positioned in sternalposition for a 3-portal left- or right-sided flank laparoscopy.A bipolar vessel sealer/divider facilitated tissue dissection.Results: Organs fall away from the pancreas in sternalposition which enables proper access with minimal needfor tissue retraction. Laparoscopic approach and dis-section of the insulinoma and distal pancreatic limb weresuccessful and without unmet difficulties. Length ofexcised tissue specimens (tumor + distal pancreatic limb)was 2.5-8 cm. A 4thportal was placed for dissection of8 cm right distal limb in the Dachshund in which theaccessory pancreatic duct was also transected. Surgeryduration, including liver biopsy in 2 cases, was66-125 minutes. Blood glucose levels increased from2.2-3.5 mmol/L preoperatively to 6.9 -9.3 mmol/L imme-diately postoperative. All dogs recovered uneventfully,were discharged from hospital after 1.5 days, and werefree of clinical signs at last follow-up (4-8 months).Conclusion: A flank approachinsternalrecumbencegreatly facilitates laparoscopic distal limb pancreatectomyand offers a minimally invasive treatment of insulinoma inselected cases. Because full abdominal exploration is impos-sible in this approach, proper disease-staging is imperative.