minimally invasive vascular surgery is currently applied to the reconstruction of major vessels only , i.e. , aorta , pelvic vessels and renal artery .
advancement in instruments , optics and gaining experience in laparoscopy will help in establishing laparoscopy as a novel technique for vascular surgery involving medium - vessels too .
a 23-year - old female presented with a cystic lesion in the distal body of the pancreas .
her serum carcinoembryonic antigen ( cea ) was 2.5 ng / dl and serum carbohydrate antigen ( ca ) 19.9 was 6.7 iu / dl .
triphasic computed tomography ( ct ) abdomen showed a 4.5 cm  3.2 cm cystic lesion in the body of the pancreas with calcifications .
the diagnosis of a mucinous cystic neoplasm was made and the patient was planned for laparoscopic distal pancreatectomy . she was placed in supine position with a 30 right lateral tilt .
pneumoperitoneum was created using a veress needle and four ports were placed ( supraumbilical for camera , epigastric , left mid - clavicular and left midaxillary as working ports ) . after assessing for metastatic disease , gastrocolic ligament was divided and access was gained to a lesser sac .
splenic flexure was mobilised to expose the inferior edge of the tail of the pancreas .
peritoneal incision was made along the inferior edge of the pancreas from body to tail .
the pancreas was then dissected off from the retroperitoneum . after completing inferior and retroperitoneal dissection ,
the common hepatic artery was accidentally clipped and divided , assuming it as the splenic artery .
the common hepatic artery was densely adherent to the pancreatic body and had an anomalous course ( i.e. , after arising from the coeliac axis , it was running to the left side just adjacent to the superior border of the body of the pancreas for a few centimetres and hence mistakenly interpreted as splenic artery ) .
abnormal course of the common hepatic artery was confirmed and primary reconstruction was planned using the left gastric artery as conduit .
distal pancreatectomy was completed , after which the distal part of the hepatic artery was mobilised .
its proximal part was occluded using endo bulldog clamp while the distal part was doubly clipped and divided , keeping adequate stump for reconstruction .
distal stump of the hepatic artery that was clipped , was exchanged to endo bulldog clamp and the edges were refashioned [ figure 1 ] .
an end - to - end anastomosis was done using a 7 - 0 prolene suture in an interrupted fashion using a 3 mm endo needle holder [ figure 2 ] .
the total duration of reconstruction was 45 min and the estimated blood loss was 75 ml .
postoperatively , the patient was observed in the intensive care unit ( icu ) for 2 days .
liver enzymes were transiently elevated on the 1st postoperative day ; they became normal by the 4th postoperative day .
she was discharged on the 7th postoperative day with an advice to continue aspirin for 90 days . refashioned ends of the hepatic and the left gastric artery at the completion of the anastomosis
the first laparoscopic - assisted technique was performed for aortoiliac disease in 1993 and purely laparoscopic aortic end - to - end repair was done in 1995 . with the advancement in instruments and gaining experience in vascular surgery , laparoscopic repair for aortoiliac disease has become the standard of care while availing benefits of minimally invasive approach , i.e. , shorter hospital stay ; less postoperative pain ; faster return to regular diet , ambulation and work ; lower incisional hernia rates ; and better cosmetic results .
the role of laparoscopy till date is limited only to the reconstruction of major vessels , i.e. , aorta , pelvic vessels and renal artery .
we are reporting the first case so far in the literature on laparoscopic reconstruction of a medium - sized vessel .
although magnification in laparoscopy is 15 - 20 times more than what appears to the naked eye , which helps in vascular reconstruction , it still remains to be used for surgery on major vessels only .
the prime limitation for laparoscopic vascular surgery is time consumption , demand for highly skilled and precise movements .
although laparoscopic vascular reconstruction is a complex procedure and requires high skills , it is feasible and safe in select patients .
 although minimally invasive surgery has evolved in every field of surgery , its use in vascular surgery is limited to major vessel diseases only . a 23-year - old female presented with a cystic lesion in the distal body and the tail of the pancreas . 
 triphasic computed tomography ( ct ) abdomen revealed a 4.5 cm  3.2 cm - sized mass with calcifications . 
 a diagnosis of the mucinous cystic neoplasm in the distal body and the tail of the pancreas was made and the patient was planned for laparoscopic distal pancreatectomy . during the procedure , hepatic artery was accidentally injured due to its anomalous course . 
 the artery was then reconstructed laparoscopically using left gastric artery as conduit . 
 the time duration of the procedure was 45 min and blood loss was approximately 75 ml . 
 the patient recovered well and the postoperative doppler study revealed normal blood flow . 
 medium - vessel surgery through laparoscopic approach is feasible and safe in select cases , while availing benefits of laparoscopy . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION
Financial Support and Sponsorship
Conflicts of Interest