title: The vascular stapler in uncinate process division during pancreaticoduodenectomy: technical considerations and results.
abstract: BACKGROUND
  Few studies describing the use of stapling devices for uncinate process division during pancreaticoduodenectomy (PD) have data regarding outcomes. Our aim is to discuss our technique and the peri-operative outcomes with the use of the linear vascular stapler for division of the uncinate process during PD.
  
  
  METHODS
  19 consecutive patients who underwent stapler division of the uncinate process ('stapler' group) were compared to 20 consecutive patients operated without stapler ('no-stapler' group).
  
  
  RESULTS
  The overall surgical morbidity in the no-stapler group was 25% (5/20) and 31.6% (6/19) in the stapler group (p = 0.731). The mean blood loss in the no-stapler group was 1,077.5 +/- 594 ml compared to 778 +/- 302 ml in the stapler group (p = 0.113). The mean operative duration was 498 +/- 105 min in the no-stapler group and 490 +/- 60 min in the stapler group (p = 0.773). The average number of lymph nodes retrieved was 6.1 +/- 3 in the no-stapler group versus 5.9 +/- 4 in the stapler group (p = 0.627). Neither group had positive resection margins.
  
  
  CONCLUSIONS
  Stapler division of the uncinate process for selected periampullary tumours compares well with the conventional method, has comparable peri-operative outcomes without compromising oncological radicality and has the potential to simplify uncinate resection.
authors.affiliation: Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Melroy A
authors.initials: MA
authors.lastname: D'souza
authors.forename: Kailash
authors.initials: K
authors.lastname: Singh
authors.forename: Rohini V
authors.initials: RV
authors.lastname: Hawaldar
authors.forename: Parul J
authors.initials: PJ
authors.lastname: Shukla
authors.forename: Shailesh V
authors.initials: SV
authors.lastname: Shrikhande
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011446:Prospective Studies; D013528:Surgical Staplers