Distal Pancreatectomy with SmartPAN®


Authors: Dr. Pausch, Thomas; El-Mahdy, Josefin. University Hospital Heidelberg, Germany

Patient

  • Female, 30 years, BMI: 21,7, Pancreas-type B (not-soft texture,
    small duct)
  • Patient was in good general condition (ASA I), no comorbidities
  • MRI-Scan showed pancreatic lesion (Fig 1)
  • Diagnosis: benign multicystic neoplasm located at the
    pancreatic tail, suspected malignant potential
  • Patient was planned for exploration laparotomy and distal
    pancreatectomy

SmartPAN®

  • First-in-class medical device to indicate pancreatic leakage during surgery.
  • Instructions:
  1. Rinse and dab operation field to ensure cleanliness and blood dryness
  2. Application of 4ml SmartPAN® on pancreatic remnant.
  3. Wait for 3 minutes and document color change.
  4. Rinse and suction to avoid accumulation in the body cavity.
  • Indicator changes color from orange to blue upon contact with pancreatic fluid specifically and with high
    optical resolution.
  • Direct visualization of pancreatic leakage in the surgical field.

Therapy: Distal pancreatectomy & SmartPAN® usage

  • Patient received an open distal pancreatectomy with Splenectomy in general anesthesia
  • Application of SmartPAN® at the resection site: indicator positive reaction showed leakage (Fig 1a)
  • Surgeon applied 2 stitches for targeted closure
  • Reapplication of SmartPAN® after targeted closure ➞ No color change visible, closure attempt successful

Outcome

  • Diameter of removed lesion: 12 cm (Fig. 4)
  • Histology: pancreatic mucinous cystic neoplasm (MCN)
    with low grade epithelial dysplasia, R0 resection
  • Patient showed no complications during the 30 day
    follow-up after the operation
  • There were no signs of clinically relevant postoperative
    pancreatic fistula in the drainage fluid and the clinical
    course. Postoperative day 2: serum: Amylase 31 U/l,
    Lipase 45 U/l ; drainage: Amylase 196 U/l, Lipase 412
    U/L;  drainage concentration on postoperative day 5:
    Amylase 16 U/l, Lipase 35 U/l
  • Drainage could be removed after 6 days
  • Patient was discharged from the hospital 7 days after distal pancreatectomy
  • Toxicological analysis of central venous blood and drainage fluid, collected during the operation and on
    postoperative day 2, showed no traces of the only non-biocompatible indicator component bromothymol
    blue (BTB)

CONCLUSION

  • SmartPAN® is easy to use during the operation
  • The surgeon can perform targeted closure of the colored spots indicating leakage to
    prevent postoperative complications following POPF
  • The toxicological analysis confirmed the safety and showed no accumulation of BTB
    in the central venous blood stream or drainage fluid of the patient