Advertisement

Surgical Endoscopy

, Volume 31, Issue 10, pp 4131–4135 | Cite as

Transduodenal–transpapillary endopancreatic surgery with a rigid resectoscope: experiments on ex vivo, in vivo animal models and human cadavers

  • Philip C. MüllerEmail author
  • Daniel C. Steinemann
  • Felix Nickel
  • Lukas Chinczewski
  • Beat P. Müller-Stich
  • Georg R. Linke
  • Kaspar Z’graggen
Article

Abstract

Background

Surgery for chronic pancreatitis is afflicted with high morbidity. A novel transduodenal–transpapillary endopancreatic resection (EPR) may provide a less invasive alternative approach.

Materials and Methods

After laparoscopic duodenotomy the papilla was dilated and accessed with a rigid resectoscope. A resection of pancreatic head tissue was performed from inside the organ. First, the feasibility and resection volume were assessed in bovine pancreas. Bleeding and intraoperative complications were evaluated in an acute in vivo pig model. Finally, the total laparoscopic approach was tested in human cadavers.

Results

EPR was feasible in 6/6 bovine and 5/6 porcine pancreases; in one case the papilla could not be located. The resected surface accounted for 30 (23–39)% of the total pancreatic surface and the resection volume was 14.2 (9–25) cm3. In vivo blood loss was minimal [10 (5–20) ml]. The operating time for EPR was 84 (75–110) min in all cadavers.

Conclusion

The EPR technique is feasible and provides a resection comparable with duodenum-preserving pancreatic head resection (DPPHR). Given the reduced surgical trauma, EPR may emerge as a minimally invasive alternative to DPPHR.

Keywords

Transpapillary resection Minimally invasive pancreatic surgery Pancreatic resection 

Notes

Funding

Philip C. Müller is supported by the Swiss Pancreas Foundation. All other authors have nothing to disclose. The work was supported by the Heidelberg Foundation of Surgery.

Compliance with ethical standards

Disclosure

Philip C. Müller, Daniel C. Steinemann, Felix Nickel, Lukas Chinczewski, Beat P. Müller-Stich, Georg R. Linke, and Kaspar Z’graggen have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MP4 45957 KB)

Supplementary material 2 (MP4 23347 KB)

References

  1. 1.
    Jimenez RE, Fernandez-del Castillo C, Rattner DW, Chang Y, Warshaw AL (2000) Outcome of pancreaticoduodenectomy with pylorus preservation or with antrectomy in the treatment of chronic pancreatitis. Ann Surg 231(3):293–300CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Cahen DL, Gouma DJ, Nio Y, Rauws EAJ, Boermeester MA, Busch OR et al (2007) Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 356(7):676–684CrossRefPubMedGoogle Scholar
  3. 3.
    Díte P, Ruzicka M, Zboril V, Novotný I (2003) A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy 35(7):553–558CrossRefPubMedGoogle Scholar
  4. 4.
    Müller-Stich BP, Senft JD, Lasitschka F, Shevchenko M, Billeter AT, Bruckner T et al (2014) Polypropylene, polyester or polytetrafluoroethylene-is there an ideal material for mesh augmentation at the esophageal hiatus? Results from an experimental study in a porcine model. Hernia 18(6):873–881CrossRefPubMedGoogle Scholar
  5. 5.
    Tan C-L, Zhang H, Li K-Z (2015) Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis. World J Gastroenterol 21(44):12644–12652CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Banz VM, Müller PC, Tinguely P, Inderbitzin D, Ribes D, Peterhans M et al (2016) Intraoperative image-guided navigation system: development and applicability in 65 patients undergoing liver surgery. Langenbecks Arch Surg 401(4):495–502CrossRefPubMedGoogle Scholar
  7. 7.
    Nickel F, Kenngott HG, Neuhaus J, Sommer CM, Gehrig T, Kolb A et al (2013) Navigation system for minimally invasive esophagectomy: experimental study in a porcine model. Surg Endosc 27(10):3663–3670CrossRefPubMedGoogle Scholar
  8. 8.
    Kondo H, Naitoh I, Ohara H, Nakazawa T, Hayashi K, Okumura F et al (2014) Efficacy of pancreatic stenting prior to extracorporeal shock wave lithotripsy for pancreatic stones. Dig Liver Dis 46(7):639–644CrossRefPubMedGoogle Scholar
  9. 9.
    Dumonceau J-M, Andriulli A, Elmunzer BJ, Mariani A, Meister T, Deviere J et al (2014) Prophylaxis of post-ERCP pancreatitis: European society of gastrointestinal endoscopy (ESGE) guideline—updated June 2014. Endoscopy 46(9):799–815CrossRefPubMedGoogle Scholar
  10. 10.
    Schmitt F, Maignan A, Ploteau S, Hamel A, Lagier S, Blin Y et al (2010) New anatomical data on the drainage patterns of the uncinate process of the pancreas. Surg Radiol Anat 32(8):777–781CrossRefPubMedGoogle Scholar
  11. 11.
    Rogers CS, Stoltz DA, Meyerholz DK, Ostedgaard LS, Rokhlina T, Taft PJ et al (2008) Disruption of the CFTR gene produces a model of cystic fibrosis in newborn pigs. Science 321(5897):1837–1841CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Uc A, Giriyappa R, Meyerholz DK, Griffin M, Ostedgaard LS, Tang XX et al (2012) Pancreatic and biliary secretion are both altered in cystic fibrosis pigs. Am J Physiol Gastrointest Liver Physiol 303(8):G961–G968CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Beger HG, Schoenberg MH, Link KH, Safi F, Berger D (1997) Duodenum-preserving pancreatic head resection—a standard method in chronic pancreatitis. Chir Z Alle Geb Oper Medizen 68(9):874–880CrossRefGoogle Scholar
  14. 14.
    Frey CF, Amikura K (1994) Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis. Ann Surg 220(4):492-504-507CrossRefGoogle Scholar
  15. 15.
    Keus E, van Laarhoven CJHM, Eddes EH, Masclee AAM, Schipper MEI, Gooszen HG (2003) Size of the pancreatic head as a prognostic factor for the outcome of Beger’s procedure for painful chronic pancreatitis. Br J Surg 90(3):320–324CrossRefPubMedGoogle Scholar
  16. 16.
    Song KB, Kim SC, Hwang DW, Lee JH, Lee DJ, Lee JW et al (2015) Enucleation for benign or low-grade malignant lesions of the pancreas: single-center experience with 65 consecutive patients. Surgery 158(5):1203–1210CrossRefPubMedGoogle Scholar
  17. 17.
    Zhang R-C, Zhou Y-C, Mou Y-P, Huang C-J, Jin W-W, Yan J-F et al (2016) Laparoscopic versus open enucleation for pancreatic neoplasms: clinical outcomes and pancreatic function analysis. Surg Endosc 30(7):2657–2665CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Philip C. Müller
    • 1
    Email author
  • Daniel C. Steinemann
    • 1
  • Felix Nickel
    • 1
  • Lukas Chinczewski
    • 1
  • Beat P. Müller-Stich
    • 1
  • Georg R. Linke
    • 1
    • 3
  • Kaspar Z’graggen
    • 2
  1. 1.Department of General, Visceral and Transplantation SurgeryUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Berner Viszeralchirurgie, Klinik Beau-Site, HirslandenBernSwitzerland
  3. 3.Department of SurgerySpital STS AG ThunThunSwitzerland

Personalised recommendations