Ra. Underwood et al., Development of a laparoscopic approach to neurolytic celiac plexus block in a porcine model, SURG ENDOSC, 14(9), 2000, pp. 839-843
Citations number
36
Categorie Soggetti
Surgery
Journal title
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
Background: Neurolytic celiac plexus block (NCPB) is an effective method of
palliative pain control in cases of inoperable pancreatic cancer. This stu
dy 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 stud
y of six domestic swine followed by a chronic study of nine domestic swine
that were monitored 3-21 days after surgery for adverse neurologic, gastroi
ntestinal, or other sequelae. Using a four-port laparoscopic technique, the
esophageal hiatus was dissected to expose the aorta at the level of the di
aphragmatic crura. Under combined endoscopic and laparoscopic ultrasound (L
US) guidance, 5 mi of sclerosant dye (95% ethanol mixed with India ink) was
injected into either side of the para-aortic soft tissue via a percutaneou
sly placed Is-gauge spinal needle. After the animals were killed, the aorta
and periaortic tissue were harvested from each animal for gross and histol
ogic analysis.
Results: Under LUS guidance, sclerosant was injected successfully into the
para-aortic soft tissue in all animals. There were no intraoperative compli
cations in the acute animal group. Placement of sclerosant injection was su
ccessful in all nine chronic cases. Two pigs in the chronic study group die
d in the immediate postoperative period secondary to pneumothorax. No adver
se neurologic, gastrointestinal, or other sequelae were observed in the rem
aining seven animals at 3-21 days postoperatively. After the animals were k
illed, we found no injuries to the aorta or esophagus, and histologic analy
sis demonstrated good placement of dye-labeled sclerosant with no compromis
e of aortic structural integrity.
Conclusion: A laparoscopic approach to the aortic hiatus and NCPB is feasib
le. Further studies are warranted to evaluate this approach in patients who
undergo staging laparoscopy for pancreatic cancer and are found to have un
resectable disease.