Distal pancreatectomy under Water-Filled Laparo-Endoscopic Surgery to confirm minimal invasiveness

Hiroshi Kawahira, MD, PhD1, Tatsuo Igarashi, MD, PhD1, Takuro Ishii, PhD1, Ryoichi Nakamura, PhD1, Yukio Naya, MD, PhD2. 1Center for Frontier Medical Engineering, Chiba University, 2Department of Urology, Teikyo University Chiba Medical Center

Objective of the technology or device

The pancreas is located in the retroperitoneal cavity and adheres to the spleen which controls the amount of blood flow. From these anatomical aspects, distal pancreatectomy requires a relatively wide range of incision. Although 1435 patients underwent laparoscopic distal pancreatectomy by 2013 in Japan, laparoscopic distal pancreatectomy has not been as common as laparoscopic surgery for other organs such as the colon, rectum or stomach. The number of laparoscopic distal pancreatectomy has been limited yet. Therefore, we conducted an initial study, using a swine, of distal pancreatectomy with a small incision and Water-Filled Laparo-Endoscopic Surgery, and report possibilities of this as minimally invasive surgery.

 

Description of the technology and method of its use or application

This experiment was approved by the ethical committee for animal experiments at Chiba University. Under general anesthesia, a male swine weighed 30kg was laid in the right 45-degree semi recumbent position on the operating table and ultra sound was performed to identify the distal part of the pancreas. 5cm vertical incision was made on the lateral abdomen and a retractor was put to retract the great omentum and small intestine. A 5mm trocar was inserted from the caudal part of the incision and Karl Storz Image 1HD laparoscopy (Karl Storz Japan, Inc. Tokyo, Japan) was used for examination. Sonicision (Covidien Japan, Inc. Tokyo, Japan) was used as an ultrasonic coagulating shears and for transection of the pancreatic body. A bipolar electrocautery (Kobayashi Medical, Osaka, Japan) was used for coagulation.

 

Preliminary results if available

The greater omentum was cut open from a small incision to enter the omental bursa and the anterior surface of the pancreas tail could been observed directly and laparoscopically. The pancreatic fascia was dissected using Sonicision by identifying the splenic artery and the splenic vein. The pancreatic body was transected by Sonicision. Minor hemorrhage was coagulated by a bipolar electric scalpel. Cavitation made by the Sonicision was a concern at first. The direct and laparoscopic view was blocked for an instant by jet bubble, but the view returned immediately. There is no effect on the procedure progress. After transecting the pancreas, damage was given to the root of the inferior mesenteric vein (IMV) which flowed into the splenic vein, and there was bleeding that required hemostasis. The pancreatic tail was resected, and the procedure was finished because the swine went into cardiac arrest.

 

Conclusions / future directions

In this study, DP under the WaFLES environment was performed using a swine. The surgery was not completed successfully because IMV was damaged and the swine went into cardiac arrest, but we managed to transect the pancreas.  It has been thought that the use of ultrasonic coagulating shears in water has difficulty in securing a field of vision, but our experiment this time showed that the use did not have any problem. This is a preliminary result of our first distal pancreatectomy by WaFLES procedure. We will pursue possibilities of distal pancreatectomy for minimal invasiveness.

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