• 1. Introduction
  • 2. Surgical Approach
  • 3. Exchange Superior Drain for 30 French Sheath
  • 4. Debridement of Necrotic Pancreatic Tissue
  • 5. Remove Sheath and Replace Drain
  • 6. Suture Drain
  • 7. Drain Study to Examine Fistula
  • 8. Exchange Inferior Drain for 30 French Sheath
  • 9. Examination of Cavity for Necrotic Tissue
  • 10. Remove Sheath and Replace Drain
  • 11. Drain Study
  • 12. Suture Drain
  • 13. Post-op Remarks
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Pancreatic Debridement via Sinus Tract Endoscopy

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Peter Fagenholz, MD
Massachusetts General Hospital

Procedure Outline

  1. Patient Positioning: A partial lateral decubitus position is often required to allow the percutaneous drain to be prepped into the field.
  2. Patient Preparation: Use a draping system that can catch the continuous irrigation. We use a neurosurgical head drape with attached collection bag.
  1. Set up and align fluoroscopy.
  2. Insert Super Stiff Amplatz guidewire into drain.
  3. Remove drain over the wire. Use fluoroscopy to be sure the wire stays in position.
  4. Enlarge incision to 1 cm.
  5. Insert dilating balloon over guidewire and inflate.
  6. Advance 30 French sheath over balloon.
  7. Deflate and remove balloon, keeping the wire in place.
  8. Insert the nephroscope to confirm placement in necrotic cavity, and remove the guidewire.
  1. Take care to avoid viable tissue on cavity borders.
  2. Remove entire scope and grasper—do not try to pull necrosis through the scope.
  3. Can work with or without continuous irrigation. Use whichever technique provides better visibility.
  1. Optional depending on cavity.
  1. Same as step 3.
  1. Same as step 4.
  1. Same as step 5.
  1. Same as step 7.
  1. Same as step 6.