Endoscopic Total Retroperitoneal Distal Pancreatectomy in a Large Animal Model

Traditionally distal pancreatic lesions are resected by the open technique. There are also increasing number of reported cases of laparoscopic transperitoneal distal pancreatectomy. This paper examines the possibility of performing distal pancreatectomy through an endoscopic totally retroperitoneal approach. The actual surgical steps are described. This study was done in 2 stages using a total of 15 pigs. The first stage involved performing the procedure in euthanased pigs. In this stage of the study a total of 6 pigs were used. All the procedures were performed in less than 35 minutes (including port placement). In all cases spleen preservation was possible. All resection margins were less than 10 mm from the portal vein. The second stage involved the use of anaesthetised pigs. A total of 9 pigs were used during this stage of the study. The total time for the procedures was slightly longer than stage 1, though all were performed in less than 45 minutes. Again, this total time includes the time taken for port insertion. The blood loss was insignificant, being less than 100 ml. In each case, the spleen could be preserved. The resection margins were less than 15 mm from the portal vein. In summary, distal pancreatectomy could be performed within an acceptable time frame and with acceptable resection margins and morbidity rate. We would like to introduce the concept of endoscopic total retroperitoneal distal pancreatectomy as an approach for distal pancreatectomy.