*4.2.3.1 Video assited retroperitoneal debridement (VARD) in infected necrotizing pancreatitis*

Several techniques have been described, such as video assisted retroperitoneal access that presents significantly lower rates of abdominal complications than the most classic techniques. This technique uses radiological drainage as a guide to the collection, hence the importance of placing it on the left side as long as possible. The tract formed by the anterior drainage is used to access the retroperitoneal space for intracavitary videoassisted necrosectomy (**Figure 6**). Traditional laparoscopic instruments are used under direct vision (**Figures 7** and **8**). We can leave wellpositioned drains that allow washing. The process may be repeated if necessary to remove the infected pancreatic necrosis. It should be noted that the VARD approach

## *Necrotizing Pancreatitis: Step Up Approach DOI: http://dx.doi.org/10.5772/intechopen.96196*

is more effective in treating central to left parietocolic infected pancreatic necrosis. However, it will be more difficult to access the necrosis located to the right of the mesenteric vessels [32] (**Figure 9**).

### **Figure 6.**

*CT scan image showing infected acute necrotic collection on the left flank. It allows a percutaneous drainage approach and subsequent laparoscopic retroperitoneal access.*

### **Figure 7.**

*Using left retroperitoneal percutaneous drainage as a guide, we can access it by minimally invasive approach. We observed laparoscopic trócar through which we introduced camera, vacuum cleaner and laparoscopic tweezers.*

**Figure 8.**

*Image of CT scan that objective retroperitoneal necrotic collection with drainage inside placed by laparoscopic retroperitoneal access.*

**Figure 9.** *CT scan showing surgical drainage on the right flank by laparoscopic retroperitoneal access.*
