Multimedia manuscript. NOTES retroperitoneal transvaginal distal pancreatectomy

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Surgical Innovation

Background:

• The retroperitoneal approach offers advantages for kidney and adrenal surgery.
• The pancreas is a potential target for retroperitoneal surgery.
• Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) combines peritoneal preservation with scarless surgery.

Purpose of the Study:

• To explore the feasibility of a transvaginal retroperitoneal NOTES approach for distal pancreatectomy.
• To evaluate the safety and efficacy of this novel surgical technique in a porcine model.

Main Methods:

• A retroperitoneal tunnel was created via posterior colpotomy using a flexible endoscope in supine pigs.
• The pancreas tail was dissected and mobilized using blunt and sharp dissection.
• Resection was performed using an endoscopic loop and snare.

Main Results:

• The transvaginal retroperitoneal NOTES pancreatectomy was successfully completed in all five pigs.
• Mean operative time was 118 minutes, with no intraoperative complications or injuries to retroperitoneal structures.

Conclusions:

• The pancreas is accessible via a transvaginal retroperitoneal NOTES approach.
• Further studies in human cadavers are needed to validate this model.
• Technological advancements, like flexible stapling devices, may enhance safety for pancreatic resection.