Fig. 2

Technique of the VARTD approach. A Schematic diagram of the VARTD technique. Videoscope is inserted through the index approaches (i.e., epigastric, left and/or right retroperitoneal incisions). B–F Representative images obtained during the VARTD procedures. B Marking for incision used in planning of a retroperitoneal access. C A videoscope is inserted into the necrosis cavity, and residual necrotic debris is shown following fluid necrotic component is irrigated and aspirated. D, E Residual necrotic debris is removed with a sponge holding forceps under visualization. PCD, percutaneous catheter drainage. F Two large-bore tubes are crosswire placed in the necrosis cavity for postoperative drainage and lavage, followed by the necrosis cavity is closed and the incision is sutured. G Schematic diagram of location of drain placement. A representative 3D abdominal image (reconstructed from CT images) of a patient with infected walled-off pancreatic necrosis is presented (the necrosis is shown in yellow color)