Development of a laparoscopic approach to neurolytic celiac plexus block in a porcine model

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.