How to Do 10 mL Syringe Port Retroperitoneal Access for Staged Minimally Invasive Pancreatic Necrosectomy

Acute necrotising pancreatitis with infected pancreatic necrosis has a significant mortality of up to 23.5%, with survival dependent on achieving a complete necrosectomy. In recent years, several minimally invasive techniques have been developed including laparoscopic and endoscopic approaches, which are feasible, well-tolerated and beneficial for the patient when compared with open surgery. Percutaneous drainage with radiologically guided drains has limited efficacy as pancreatic necrosis is mostly solid tissue, but these drains can guide the surgeon to areas of infected necrosis. We present our experience in utilising 10 mL syringes as ports for retroperitoneal access to perform staged pancreatic necrosectomies, allowing the operator to use both the nephroscope and the gastroscope to visually guide the removal of necrotic tissue, the drainage of infected fluid and the placement of drains. This is a cost-effective technique using widely available equipment and can be easily adopted.