caa a22 4500 475779282 CHVBK 20180406123639.0 cr unu---uuuuu 170329e20000901xx s 000 0 eng 10.1007/s004640000173 doi (NATIONALLICENCE)springer-10.1007/s004640000173 Development of a laparoscopic approach to neurolytic celiac plexus block in a porcine model [Elektronische Daten] [R. A. Underwood, J. S. Wu, M. A. Quasebarth, L. M. Brunt] Background: Neurolytic celiac plexus block (NCPB) is an effective method of palliative pain control in cases of inoperable pancreatic cancer. This study was undertaken to evaluate the feasibility of a laparoscopic approach to NCPB in an experimental animal model. Methods: The laparoscopic technique for NCPB was developed in an acute study of six domestic swine followed by a chronic study of nine domestic swine that were monitored 3-21 days after surgery for adverse neurologic, gastrointestinal, or other sequelae. Using a four-port laparoscopic technique, the esophageal hiatus was dissected to expose the aorta at the level of the diaphragmatic crura. Under combined endoscopic and laparoscopic ultrasound (LUS) guidance, 5 ml of sclerosant dye (95% ethanol mixed with India ink) was injected into either side of the para-aortic soft tissue via a percutaneously placed 18-gauge spinal needle. After the animals were killed, the aorta and periaortic tissue were harvested from each animal for gross and histologic analysis. Results: Under LUS guidance, sclerosant was injected successfully into the para-aortic soft tissue in all animals. There were no intraoperative complications in the acute animal group. Placement of sclerosant injection was successful in all nine chronic cases. Two pigs in the chronic study group died in the immediate postoperative period secondary to pneumothorax. No adverse neurologic, gastrointestinal, or other sequelae were observed in the remaining seven animals at 3-21 days postoperatively. After the animals were killed, we found no injuries to the aorta or esophagus, and histologic analysis demonstrated good placement of dye-labeled sclerosant with no compromise of aortic structural integrity. Conclusion: A laparoscopic approach to the aortic hiatus and NCPB is feasible. Further studies are warranted to evaluate this approach in patients who undergo staging laparoscopy for pancreatic cancer and are found to have unresectable disease. Springer-Verlag New York Inc., 2000 Key words: Laparoscopic surgery — Neurolytic celiac plexus block — Pain palliation — Pancreatic cancer nationallicence Underwood R. A. Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110, USA, USA aut Wu J. S. Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110, USA, USA aut Quasebarth M. A. Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110, USA, USA aut Brunt L. M. Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110, USA, USA aut Surgical Endoscopy Springer-Verlag 14/9(2000-09-01), 839-843 0930-2794 14:9<839 2000 14 464 https://doi.org/10.1007/s004640000173 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640000173 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Underwood R. A. Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110, USA, USA aut NATIONALLICENCE 700 1- Wu J. S. Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110, USA, USA aut NATIONALLICENCE 700 1- Quasebarth M. A. Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110, USA, USA aut NATIONALLICENCE 700 1- Brunt L. M. Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO 63110, USA, USA aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/9(2000-09-01), 839-843 0930-2794 14:9<839 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer