The frequency of total pancreatectomy performed for pancreatic pathology is increasing due to improved perioperative care and control of subsequent endocrine and exocrine insufficieny, as well as the increased recognition of familial pancreatic syndromes and diffuse pancreatic disease. We present a case of a totally laparoscopic total pancreatectomy.

A 37 year old female was a history of MEN type I found to have multicentric pancreatic neuroendocrine tumors. She was considered a candidate for laparoscopic total pancreatectomy.

A laparoscopic total pancreatectomy was performed. The steps include inferior mobilization of the transverse colon. Exposure of the entire pancreas by entering into the lesser sac. Exposure of the SMV and dissection of the neck of the pancreas off of the superior mesenteric vein. Kocher manuever and SMA exposure with uncinate process dissection. En-bloc mobilization from medial to lateral after transection of the common bile duct and GDA. Reconstructive hepaticojejunostomy and gastrojejunostomy. The patient recovered uneventfully and was discharged 7 days later without complications.

Total pancreatectomy is feasible and can be performed safely through a minimal access approach in selected patients.