Feasibility of endoscopic transgastric distal pancreatectomy in a porcine animal model

BackgroundIn contrast to laparoscopic tubal ligation, oophorectomy, and appendectomy, laparoscopic distal pancreatectomy is associated with a morbidity rate of more than 50% and a mortality rate of more than 3%.ObjectiveTo develop a minimally invasive, transgastric endoscopic technique for distal pancreatectomy in a nonsurvival series in swine.DesignExperimental study.SettingAnimal trial at a tertiary-care academic hospital.SubjectsSix healthy Yorkshire swine under general anesthesia.InterventionsA double-channel gastroscope was introduced into the stomach, and a gastric incision was created by using a triple-lumen, 4-mm, cutting-wire needle knife. The peritoneal cavity was accessed. An Endoloop was placed endoscopically around the distal aspect of the pancreas, and the tail of the pancreas was transected by using a diathermic snare. One to 3 hemoclips were placed across the pancreatic duct. The pancreatic specimen was retrieved, and the gastrotomy was closed endoscopically with metal clips. The animals were euthanized after the procedure. The abdominal cavity was examined grossly, and the resected pancreas was examined histologically.Main Outcome and MeasurementsFeasibility of endoscopic transgastric distal pancreatectomy and rate of complications.ResultsThe pancreatic tail was successfully resected via a transgastric endoscopic approach in all animals. The procedure took an average (standard deviation) of 77.3 ± 18.9 minutes. There was 1 complication, an episode of bleeding from a splenic laceration, which resulted in the loss of 250 mL of blood.LimitationsNonsurvival series, animal study.ConclusionsTransgastric endoscopic distal pancreatectomy is technically feasible and can be performed in the porcine animal model.