Pure flexible endoscopic lobular resection of the pancreas: a pilot experiment in the porcine model

Aims Currently, resection of the pancreatic body and tail typically involves invasive surgery, primarily laparoscopic techniques. While laparoscopic surgery is a well-established method with a complication rate of about 10%, it requires significant skill and experience. In cases with persistent symptoms or unclear diagnoses, more invasive procedures are often necessary. This study investigates the potential for endoscopic treatments to directly remove lesions in the pancreatic body or tail, aiming to enhance recovery times through animal experiments.

Natural orifice transluminal endoscopic surgery (NOTES) has gained attention as a minimally invasive technique with benefits such as reduced trauma and quicker recovery without external scars. Although experimental studies have shown promising results, concerns about the safety and feasibility of NOTES remain, necessitating further exploration of its application.

Methods This study was conducted at Zhengzhou University’s animal experiment center, following ethical approval. Five pigs (average weight 35 kg) underwent general anesthesia after fasting for six hours. EUS was utilized to locate the pancreatic body, and fine-needle injection was performed to mark the puncture site. An endoscope was inserted to create an incision in the gastric wall, allowing access to the peritoneum. A section of pancreatic tissue was then removed using electrocautery, and the incision was closed with endoclips.

Results All procedures were successfully executed with no complications, achieving a 100% technical success and survival rate among the pigs. Postoperative evaluations showed normal recovery. A total of five pancreatic tissue samples were obtained, measuring approximately 2.2 cm, and all animals were observed for 12 weeks before euthanasia.

Conclusions While laparoscopic resection remains the standard for pancreatic lesions, NOTES offers an ultra-minimally invasive alternative. Key challenges include ensuring a proper visual field and effective entry site closure. Our findings indicate that endoscopic approaches can effectively identify and access the pancreas, with endoclips proving reliable for wound closure. Though some risk of pancreatic leakage exists, the protective measure of the endoclips can contain minor leaks without leading to severe complications, supporting the efficacy and relative safety of this endoscopic method.

Publication History

Article published online:
27 March 2025