title: Slow parenchymal flattening technique for distal pancreatectomy using an endopath stapler: simple and safe technical management.
abstract: OBJECTIVE
  The appropriate closure of the pancreatic remnant after a distal pancreatectomy remains controversial. To describe a safer and simple distal pancreatectomy using an endopath stapler, with special emphasis on the slow parenchymal flattening technique.
  
  
  METHODS
  The slow parenchymal flattening technique (SFT) for a distal pancreatectomy using an endopath stapler (Echelon 60) was applied to avoid a destruction of pancreas capsule and parenchyma for a soft friable pancreas. In this technique, the pancreas was gently compressed with an atraumatic intestinal clamp for a few minutes prior to the stapling dissection. Then, the closure jaw of endopath stapler was closed carefully and slowly taking more than 5 minutes at the fixed speed before dissection.
  
  
  RESULTS
  SFT using the Echelon 60 was performed for 22 consecutive patients who required a distal pancreatectomy. Only one patient (4.5%) developed a symptomatic pancreatic fistula (ISGPF classification grade B). There were no mortalities or severe pancreatic fistula (ISGPF classification grade C) in this series.
  
  
  CONCLUSIONS
  The SFT using the Echelon 60 can be performed easily, which enables surgeons to achieve confident pancreas stump without any tissue injury.
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Kita-gun, Miki-cho, Kagawa 761-0793, Japan. kokano@kms.ac.jp
authors.forename: Keiichi
authors.initials: K
authors.lastname: Okano
authors.forename: Keitaro
authors.initials: K
authors.lastname: Kakinoki
authors.forename: Hironobu
authors.initials: H
authors.lastname: Suto
authors.forename: Minoru
authors.initials: M
authors.lastname: Oshima
authors.forename: Norikatu
authors.initials: N
authors.lastname: Maeda
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kashiwagi
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Shintaro
authors.initials: S
authors.lastname: Akamoto
authors.forename: Masao
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Hirotake
authors.initials: H
authors.lastname: Takama
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hagiike
authors.forename: Hisashi
authors.initials: H
authors.lastname: Usuki
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000295:instrumentation / Q000379:methods*; D013528:Surgical Staplers