OBJECTIVE: The advantage of retroperitoneoscopy in renal and adrenal gland surgery has been widely acknowledged. Retroperitoneoscopy may also be a useful approach to the pancreas, a retroperitoneal organ. This study aims to evaluate the feasibility of retroperitoneoscopic pancreatectomy performed in an animal model and a small patient cohort. METHODS: This study was divided into two stages. Initially, retroperitoneoscopic distal pancreatectomy was performed in 6-month-old Yorkshire breed piglets (n = 5; mean weight, 50 ± 5 kg). Subsequently, seven patients with suspected diagnosis of distal pancreatic lesions were selected between February 2010 and April 2011 to undergo retroperitoneoscopy. Approval was obtained from both the Animal Ethics Committee and the Institutional Review Board. RESULTS: In the animal models, retroperitoneoscopic procedures were accomplished smoothly with short operative time, insignificant blood loss, and only minor complications. In clinical practice, patients with histologically confirmed pancreatic diseases underwent enucleation (n = 2) or distal pancreatectomy with splenic preservation (n = 2). Operative times ranged from 30 to 100 min with controllable blood loss of 10-100 ml. One case of intraoperative retroperitoneal perforation and two cases of pancreatic fistula occurred. All four patients were discharged within 7 days postoperatively. The other three patients with nonpancreatic diseases underwent retroperitoneoscopic resection with excellent clinical outcome. CONCLUSIONS: The results of this preliminary study demonstrate that retroperitoneoscopic pancreatectomy, a novel surgical approach, was feasible and effective in selected patients. The advantages of this approach include acceptable operating time, insignificant blood loss, simple manipulations, minor complications, and excellent postoperative recovery time. Additionally, this study suggests that retroperitoneoscopy could also be feasible for treatment of retroperitoneal nonpancreatic diseases.
OBJECTIVE: The advantage of retroperitoneoscopy in renal and adrenal gland surgery has been widely acknowledged. Retroperitoneoscopy may also be a useful approach to the pancreas, a retroperitoneal organ. This study aims to evaluate the feasibility of retroperitoneoscopic pancreatectomy performed in an animal model and a small patient cohort. METHODS: This study was divided into two stages. Initially, retroperitoneoscopic distal pancreatectomy was performed in 6-month-old Yorkshire breed piglets (n = 5; mean weight, 50 ± 5 kg). Subsequently, seven patients with suspected diagnosis of distal pancreatic lesions were selected between February 2010 and April 2011 to undergo retroperitoneoscopy. Approval was obtained from both the Animal Ethics Committee and the Institutional Review Board. RESULTS: In the animal models, retroperitoneoscopic procedures were accomplished smoothly with short operative time, insignificant blood loss, and only minor complications. In clinical practice, patients with histologically confirmed pancreatic diseases underwent enucleation (n = 2) or distal pancreatectomy with splenic preservation (n = 2). Operative times ranged from 30 to 100 min with controllable blood loss of 10-100 ml. One case of intraoperative retroperitoneal perforation and two cases of pancreatic fistula occurred. All four patients were discharged within 7 days postoperatively. The other three patients with nonpancreatic diseases underwent retroperitoneoscopic resection with excellent clinical outcome. CONCLUSIONS: The results of this preliminary study demonstrate that retroperitoneoscopic pancreatectomy, a novel surgical approach, was feasible and effective in selected patients. The advantages of this approach include acceptable operating time, insignificant blood loss, simple manipulations, minor complications, and excellent postoperative recovery time. Additionally, this study suggests that retroperitoneoscopy could also be feasible for treatment of retroperitoneal nonpancreatic diseases.
Authors: Field F Willingham; Denise W Gee; Patricia Sylla; Avinash Kambadakone; Anand H Singh; Dushyant Sahani; Mari Mino-Kenudson; David W Rattner; William R Brugge Journal: Gastrointest Endosc Date: 2009-06-27 Impact factor: 9.427