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

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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.

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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.

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany

    Philip C. Müller, Daniel C. Steinemann, Felix Nickel, Lukas Chinczewski, Beat P. Müller-Stich & Georg R. Linke

  2. Berner Viszeralchirurgie, Klinik Beau-Site, Hirslanden, Bern, Switzerland

    Kaspar Z’graggen

  3. Department of Surgery, Spital STS AG Thun, Thun, Switzerland

    Georg R. Linke

Authors
  1. Philip C. Müller
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  2. Daniel C. Steinemann
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  3. Felix Nickel
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  4. Lukas Chinczewski
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  5. Beat P. Müller-Stich
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  6. Georg R. Linke
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  7. Kaspar Z’graggen
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Corresponding author

Correspondence to Philip C. Müller.

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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.

Additional information

The preliminary results of this study were presented at the 103rd Annual Meeting of the Swiss Surgical Society in Lugano, Switzerland, June 1–3, 2016 and at the 24th International Congress of the European Association for Endoscopic Surgery in Amsterdam, Netherlands, June 15–18, 2016.

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Müller, P.C., Steinemann, D.C., Nickel, F. et al. Transduodenal–transpapillary endopancreatic surgery with a rigid resectoscope: experiments on ex vivo, in vivo animal models and human cadavers. Surg Endosc 31, 4131–4135 (2017). https://doi.org/10.1007/s00464-017-5465-5

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  • DOI: https://doi.org/10.1007/s00464-017-5465-5

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