Minimally invasive approaches to pancreatectomy have been demonstrated to be safe and oncologically equivalent in selected patients and in the hands of experienced surgeons. Distal pancreatectomy (also known as left pancreatectomy) is particularly amenable to a laparoscopic approach because critical structures may be more clearly seen, particularly in morbidly obese patients, than during open surgery. Laparoscopic resection has been shown to result in reduced blood loss and shortened hospital stay without compromising oncologic integrity. Several approaches to this operation have been described. As with any laparoscopic procedure, indications should not change based on the technique available and conversion to open is always acceptable and necessary for uncontrollable bleeding or surgeon discomfort.

Laparoscopic access to the lesser sac is gained in a similar fashion as that employed during open surgery. The gastrocolic omentum is opened wide and the stomach reflected cephalad, with the colon displaced caudad. Most laparoscopic pancreatic procedures are performed with the patient positioned supine with split legs (similar to laparoscopic Nissen) or in the right lateral decubitus position with a slight 45-degree angulation.

This chapter shows laparoscopic distal pancreatectomy with and without splenectomy. Hand-assisted techniques are referenced at the end of the chapter, as are less common pancreatic resections, such as enucleation of islet cell tumors and resection of head of pancreas.