Videothoracoscopic Simultaneous Bilateral Posterior Splanchnicectomy - Initial Report

Abstract

Chronic pain syndrome (CPS), accompanying pancreatic diseases, especially chronic pancreatitis and pancreatic cancer requires the strongest analgesic agents and is considered difficult to manage. Conservative methods are unsatisfactory and their side effects lead to serious somatic and mental comorbidities. The aim of the study was to perform an initial evaluation of videothoracoscopic bilateral splanchnicectomy using the posterior approach, as the method of treatment in cases of advanced pancreatic cancer. Material and methods. During the period between May and July 2005 there were 10 simultaneous bilateral videothoracoscopic splanchnicectomies (BVSPL) performed in patients with chronic pain syndrome, due to advanced pancreatic cancer, at the Department of General, Endocrinological and Transplant Surgery, Medical University of Gdańsk. Results. All patients were discharged from the hospital on the second postoperative day. Subjective pain measured by the VAS scale changed from 84.3±7.6% before the operation to 25.3±5.3% during the first and second postoperative days. The median follow-up of patients was approximately 4 months (ranging between 2 and 6 months). The intensity of pain 2, 6, and 12 weeks after the procedure was 28.7±4.7%, 30.3±5.4% and 36.2±4.7%, respectively. Conclusions. This is the first description of this safe and feasible method in the Polish surgical literature. The surgical procedure can be safely performed in most surgical departments equipped with videoscopic instruments. Moreover, the short learning curve enables surgeons to perform this procedure well after a short training period. In combination with good results concerning subjective pain reduction, it can be concluded that BVSPL should be incorporated into the spectrum of surgical procedures in most surgical departments in Poland.

Assessment of quality of life in patients with non-operated pancreatic cancer after videothoracoscopic splanchnicectomy.

“…Chemical blockades using phenol or alcohol introduced to limit invasiveness did not measure up to expectations due to the lesser efficiency and necessity of repetition [21]. Videothoracoscopy eliminates the above-mentioned inconveniences as a mini-invasive technique allowing for effective and safe excision of visceral nerves and trunks [33, 34]. Of course, this type of procedure is not entirely fault-free.…”