title: How do we apply video-assisted retroperitoneal necrosectomy with minimal access?
abstract: BACKGROUND
  The conservative treatment of acute necrotizing pancreatitis has greatly improved due to broad antibiotic treatment and improved organ support in intensive care units. Nevertheless, infected necrosis or persistent multi-organ dysfunction are predictors of poor outcome. In these patients, there is still a need to perform necrosectomy. Open surgery results in extensive operative trauma and is associated with high morbidity and mortality. Therefore, several minimally invasive techniques have been developed recently. Retroperitoneal necrosectomy has been shown to be safe and to reduce morbidity and mortality compared to the open procedure.
  
  
  RESULTS
  In an instructive video, we show the technique of video-assisted retroperitoneal necrosectomy with minimal access, including the preoperative percutaneous drainage and several accesses to the necrosis. We discuss the indication for retroperitoneal necrosectomy as well as the optimal time point of the intervention.
  
  
  CONCLUSIONS
  In the management of acute necrotizing pancreatitis, the multidisciplinary approach is crucial. The initial treatment by the intensive care units should be extended to intervention or surgery in case of infected necrosis or persistent multi-organ dysfunction. We show here a minimal access solution with the placement of a percutaneous drain followed by video-assisted retroperitoneal necrosectomy.
authors: Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland.
authors: Anna Silvia
authors: AS
authors: Wenning
authors: Eliane
authors: E
authors: Angst
authors: Antje
authors: A
authors: Lechleiter
authors: Jean-Jacques
authors: JJ
authors: Brugger
authors: Daniel
authors: D
authors: Candinas
authors: Beat
authors: B
authors: Gloor
mesh_terms: D004322:Drainage / Q000379:methods; D006801:Humans; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery*; D020535:Video-Assisted Surgery / Q000379:methods*