Two anatomical pathways for retroperitoneoscopic pancreatectomy: indications for the posterior and lateral approaches.

Background: Retroperitoneoscopic pancreatectomy (RP) is a novel surgical procedure that is safe and feasible in animal models and clinical practice. However, the optimal approach for RP has not been established.

Objective: This study aimed to introduce the posterior and lateral approaches for RP.

Methods: This prospective study included 19 patients with suspected pancreatic lesions who underwent RP. RP was performed using either a posterior or a lateral approach.

Results: The posterior, lateral, and jointed approaches were used in 13 (68.4 %), 3 (15.8 %), and 3 (15.8 %) cases, respectively. Patients underwent enucleation (N = 8), distal pancreatectomy (N = 4), and resection of cystic pancreatic lesions (N = 2) and non-pancreatic lesions (N = 5). All retroperitoneoscopic procedures were successfully accomplished with no conversion to open or laparoscopic surgery. Intraoperative complications occurred in two (12.5 %) cases, including one case with injury to the peritoneum and one case with injury to the peritoneum and splenic vein. Postoperative grade A pancreatic fistulas occurred in six cases, and were cured by delayed drainage. No disease recurrence or abnormal symptoms were observed during the mean follow-up period of 14.06 ± 9.60 months.

Conclusions: RP using the posterior or lateral approach is feasible and effective, but has different indications. The posterior approach is useful for distal pancreatectomy, as well as resection of pancreatic lesions in the posterior or superoposterior region of the distal pancreas. The lateral approach is useful for resection of pancreatic lesions in the anterior or inferior region of the body and tail. The two approaches can be used in combination or conversion.