Feasibility of endoscopic transgastric distal pancreatectomy in a porcine animal model

Background: In 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%. Objective: To develop a minimally invasive, transgastric endoscopic technique for distal pancreatectomy in a nonsurvival series in swine. Design: Experimental study. Setting: Animal trial at a tertiary-care academic hospital. Subjects: Six healthy Yorkshire swine under general anesthesia. Interventions: A 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 encloscopically 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 Measurements: Feasibility of endoscopic transgastric distal pancreatectomy and rate of complications. Results: The 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 I complication, an episode of bleeding from a splenic laceration, which resulted in the loss of 250 mL of blood. Limitations: Nonsurvival series, animal study. Conclusions: Transgastric endoscopic distal pancreatectomy is technically feasible and can be performed in the porcine animal model.