Single-port transgastric access for repeated debridement of infected pancreatic necrotic tissue.

our institution: repeated single-port transgastric debridement of walled-off pancreatic necrotic tissue using TriPort Access System (Olympus,Warsaw, Poland). After routine endotracheal intubation, gastric insufflation with a gastroscope is carried out to obtain approximation of the anterior gastric and abdominal walls. Percutaneous gastropexy is then carried out to stabilize the port insertion site. This is followed by a skin and fascial incision (1.5–2 cm) and opening of the anterior gastric wall (under gastroscopic view). The port introducer is inserted into the lumen of the stomach and the TriPort Access System (port) is securely positioned and fixed as recommended by manufacturer (●" Fig. 1). From this point both anterior abdominal and anterior gastric walls are embraced by the port. The laparoscope is introduced and the posterior wall of the stomach is visualized; the gastroscope is retracted. Two 5-mm instruments are introduced: articulating grasper and LigaSure V Sealer/Divider (Valleylab, Covidien, Warsaw, Poland). Next, a 3–4-cm incision is made in the posterior wall of the stomach (optionally under ultrasound guidance) toenable extensive lavageandgentle debridement of the necrotic tissue under direct vision (●" Video 1). A Flocare tube (Nutricia Polska, Warsaw, Poland) is inserted and a drain is introduced and positioned in the lesser sac for continuous lavage (●" Fig. 2). The instruments are removed and the patient transferred to the intensive care unit with the port in place. Repeated explorations are now possible without endoscopic assistance. Opening of the port’s cap enables direct debridement with open surgery instrumentation (●" Fig. 3). Continuous lavage is also possible between revisions. Single-port transgastric access for repeated debridement of infected pancreatic necrotic tissue