Abstract
Background
The retroperitoneal approach preserves the peritoneal cavity and its envelope. The benefits of laparoscopic retroperitoneal approach to the kidney and the adrenal gland are well known. The pancreas may represent another potential target. Whereas NOTES transperitoneal distal pancreatectomy has been reported, the retroperitoneal approach, which may combine the advantages of peritoneal preservation with those of no scar surgery, has never been explored. We report the feasibility of NOTES transvaginal retroperitoneal pancreatectomy in a porcine model.
Methods
With the pig supine, under general anesthesia, a 10-mm posterior colpotomy was performed with a needle-knife operated through a flexible 12-mm, double-channel endoscope (Karl Storz®). A retroperitoneal tunnel was created with blunt dissection up to the left kidney with progressive visualization of the left iliac vessels, ureter, and abdominal aorta. To reach the posterior aspect of the pancreas, a space was opened medial to the upper renal pole dividing the Gerota’s fascia. The tail of pancreas was mobilized with blunt and sharp dissection, using monopolar cautery. Once the distal pancreas was dissected free, it was secured using a polypropylene endoscopic loop and then resected with an endoscopic snare (Olympus®).
Results
The procedure was successfully accomplished by a totally NOTES approach in five pigs, with a mean operative time of 118 (range, 105–185) minutes with no intraoperative complications and no injury to any retroperitoneal structure.
Conclusions
The pancreas is accessible by a transvaginal retroperitoneal NOTES approach. Human cadavers studies are necessary to confirm the validity of this model and to explore the need for specific technological developments, such as flexible stapling devices, to improve the safety of pancreatic resection.
Similar content being viewed by others
References
Cadeddu MO, Mamazza J, Schlachta CM, Seshadri PA, Poulin EC (2001) Laparoscopic excision of retroperitoneal tumors: technique and review of the laparoscopic experience. Surg Laparosc Endosc Percutan Tech 11:144–147
Molina WR, Desai MM, Ng CS, Spaliviero M, Gill IS (2004) Retroperitoneoscopic radical nephrectomy with concomitant distal pancreatectomy: case report. J Endourol 18:665–667
Takada M, Ichihara T, Toyama H, Suzuki Y, Kuroda Y (2004) Retroperitoneoscopic laparoscopic distal pancreatectomy with spleen salvage. Hepatogastroenterology 51:925–927
Connor S, Ghaneh P, Raraty M, Sutton R, Rosso E, Garvey CJ, Hughes ML, Evans JC, Rowlands P, Neoptolemos JP (2003) Minimally invasive retroperitoneal pancreatic necrosectomy. Dig Surg 20:270–277 Epub 2003 May 15
Nakasaki H, Tajima T, Fujii K, Makuuchi H (1999) A surgical treatment of infected pancreatic necrosis: retroperitoneal laparotomy. Dig Surg 16:506–511
Fagniez PL, Rotman N, Kracht M (1989) Direct retroperitoneal approach to necrosis in severe acute pancreatitis. Br J Surg 76:264–267
Nagakawa T, Kurachi M, Konishi K, Miyazaki I (1982) Translateral retroperitoneal approach in radical surgery for pancreatic carcinoma. Jpn J Surg 12:229–233
Ryou M, Fong DG, Pai RD, Tavakkolizadeh A, Rattner DW, Thompson CC (2007) Dual-port distal pancreatectomy using a prototype endoscope and endoscopic stapler: a natural orifice transluminal endoscopic surgery (NOTES) survival study in a porcine model. Endoscopy 39:881–887
Matthes K, Yusuf TE, Willingham FF, Mino-Kenudson M, Rattner DW, Brugge WR (2007) Feasibility of endoscopic transgastric distal pancreatectomy in a porcine animal model. Gastrointest Endosc 66:762–766
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Supplementary material 1 (MPG 93545 kb)
Rights and permissions
About this article
Cite this article
Allemann, P., Perretta, S., Asakuma, M. et al. NOTES retroperitoneal transvaginal distal pancreatectomy. Surg Endosc 23, 882–883 (2009). https://doi.org/10.1007/s00464-008-0297-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-008-0297-y