Use of a short cartridge stapler is beneficial in pancreatic transection at the neck during laparoscopic distal pancreatectomy

• Published in: Surgery today (Tokyo, Japan) Japan), 2023, Vol.53 (1), p.153-157
• Main Authors: Ishida, Jun, Toyama, Hirochika, Asari, Sadaki, Goto, Tadahiro, Nanno, Yoshihide, Mizumoto, Takuya, Tsugawa, Daisuke, Komatsu, Shohei, Kuramitsu, Kaori, Yanagimoto, Hiroaki, Kido, Masahiro, Fukumoto, Takumi
• Format: Article
• Language: English
• Subjects: How To Do It; Humans; Laparoscopy - methods; Medicine; Medicine & Public Health; Pancreas - surgery; Pancreatectomy - methods; Pancreatic Fistula - etiology; Pancreatic Fistula - prevention & control; Postoperative Complications - prevention & control; Surgery; Surgical Oncology; Surgical Stapling - methods
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-022-02540-5

Stapling is the standard method for pancreatic transection during laparoscopic distal pancreatectomy. Although most surgeons use a 60 mm cartridge stapler, space limitations created by laparoscopic surgery make the instrument difficult to handle, especially during pancreatic transection at the neck. Therefore, we currently use a 45 mm cartridge stapler for laparoscopic pancreatic transection at the neck. Between October 2019 and December 2020, we performed pancreatic transection using a 45 mm cartridge stapler in 27 patients. Fifteen patients experienced biochemical leakage, but no patients developed clinically relevant pancreatic fistula. The compactness of the 45 mm cartridge has several benefits: (1) less space is required for flexing, opening, and closing the device; (2) it enables easy insertion of the lower jaw behind the pancreas, even if the dissected space behind the pancreas is narrow; (3) less obstruction of the surgeons’ view prevents accidental injury to the surrounding tissues and vessels. These benefits may enable safe pancreatic transection.