title: Thoracoscopic splanchnicectomy for the relief of intractable abdominal pain.
abstract: Video-thoracoscopic transthoracic splanchnicectomy has been applied to patients in the end stage of pancreas cancer who had intractable pain mediated through the splanchnic nerve in the left upper quadrant. The procedure is performed under general anesthesia in a right hemilateral position. Following the establishment of access to the thoracic cavity, the left splanchnic nerve is cut off at the level immediately above the aortic hiatus, through a small opening made in the pleura between the descending aorta and the vertebrae. All patients had immediate and complete relief of pain postoperatively. Only a transient drop in the mean arterial pressure was observed immediately after cutting off the nerve. No other detrimental effect of the procedure on the general condition was observed. No patients developed postoperative complications. The present method may, thus, be a treatment of choice directed toward the relief of intractable abdominal pain in selected patients with pancreatic cancer.
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Takahashi
authors.forename: A
authors.initials: A
authors.lastname: Kakita
authors.forename: H
authors.initials: H
authors.lastname: Izumika
authors.forename: Z
authors.initials: Z
authors.lastname: Iino
authors.forename: K
authors.initials: K
authors.lastname: Furuta
authors.forename: M
authors.initials: M
authors.lastname: Yoshida
authors.forename: Y
authors.initials: Y
authors.lastname: Hiki
mesh_terms: D015746:Abdominal Pain / Q000601:surgery*; D000368:Aged; D000768:Anesthesia, General; D001013:Aorta, Thoracic; D001794:Blood Pressure; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000503:physiopathology; D010994:Pleura / Q000601:surgery; D011183:Postoperative Complications; D013153:Splanchnic Nerves / Q000601:surgery*; D013904:Thoracic Vertebrae; D013906:Thoracoscopy; D014741:Video Recording