Single-port videoscopic splanchnotomy for palliation of refractory chronic pancreatitis

OBJECTIVES: Interrupting the afferent signals that travel through the splanchnic nerves by multiportal thoracoscopic splanchnotomy can offer effective palliation in chronic pancreatitis. However, obtained results weaken after time, possibly necessitating repeat procedures. Given the palliative nature of this procedure, potential for iatrogenic damage should be kept at a minimum. So, in order to minimize invasiveness while optimizing repeatability, we sought to create an easily reproducible single-access port operative strategy. METHODS: Four patients suffering from intractable pain due to chronic pancreatitis for > 10 years (12.8 +/- 5.9) underwent a single-port unilateral R5-R11 splanchnotomy. RESULTS: Postoperative recovery was uneventful. No operative complications were observed. All 4 patients experienced excellent pain relief with a significant improvement of Visual Analogue Scale pain scores (8.8 +/- 1.0 preoperatively to 3.0 +/- 1.2 postoperatively, P = 0.003). CONCLUSIONS: We report the first series of single-port video-assisted thoracoscopic surgical (VATS) splanchnotomy for palliation of intractable pain due to chronic pancreatitis. From this small study, single-port VATS splanchnotomy seems to be a safe and effective alternative to multiportal or open procedures.