Retroperitoneoscopic distal pancreatectomy: a new surgical approach

Area of Science:

• Minimally Invasive Surgery
• Surgical Anatomy
• Gastrointestinal Surgery

Background:

• Traditional laparoscopic surgery poses challenges for deep pancreatic lesions, risking visceral organ injury and complications like abdominal adhesion.
• Retroperitoneoscopy offers a potential solution to overcome the limitations of conventional laparoscopic approaches in pancreatic surgery.

Purpose of the Study:

• To introduce the retroperitoneoscopic pancreatic surgery procedure.
• To evaluate the clinical feasibility and safety of retroperitoneoscopy in pancreatic surgery.

Main Methods:

• Retrospective analysis of patients undergoing retroperitoneal pancreatectomy.
• Observation of anatomical features, fascial planes, and surgical pathways during the procedure.
• Evaluation of operative time, blood loss, pancreatic fistula, recovery, and hospital stay.

Main Results:

• All three patients experienced smooth operations without serious complications.
• Identification of a vascularized plane between pancreatic and prerenal fascia, crucial for avoiding visceral and vascular injury.
• Establishment of the anterior renal fascia as the safe posterior boundary for dissection.

Conclusions:

• Dissection based on fascial anatomy provides a safe, rapid, and effective surgical approach.
• The inter-prerenal fascia plane is confirmed as the correct and safe anatomical plane for retroperitoneoscopic posterior surgery.