title: Radiofrequency is a secure and effective method for pancreatic transection in laparoscopic distal pancreatectomy: results of a randomized, controlled trial in an experimental model.
abstract: BACKGROUND
  Postoperative pancreatic fistula (PPF) is the most frequent and serious complication after laparoscopic distal pancreatectomy (LDP). Our goal was to compare the performance, in terms of PPF prevention, and safety of a radiofrequency (RF)-assisted transection device versus a stapler device in a porcine LDP model.
  
  
  METHODS
  Thirty-two animals were randomly divided into two groups to perform LDP using a RF-assisted device (RF group; n = 16) and stapler device (ST group; n = 16) and necropsied 4 weeks after surgery. The primary endpoint was the incidence of PPF. Secondary endpoints were surgery/transection time, intra/postoperative complications/deaths, postoperative plasmatic amylase and glucose concentration, peritoneal liquid amylase and interleukin 6 (IL-6) concentrations, weight variations, and histopathological changes.
  
  
  RESULTS
  Two clinical and one biochemical PPF were observed in the ST and RF groups respectively. Peritoneal amylase concentration was significantly higher in the RF group 4 days after surgery, but this difference was no longer present at necropsy. Both groups presented a significant decrease in peritoneal IL-6 concentration during the postoperative follow-up, with no differences between the groups. RF group animals showed a higher postoperative weight gain. In the histopathological exam, all RF group animals showed a common pattern of central coagulative necrosis of the parenchymal surface, surrounded by a thick fibrosis, which sealed main and secondary pancreatic ducts and was not found in ST group.
  
  
  CONCLUSIONS
  The fibrosis caused by an RF-assisted device can be at least as safe and effective as stapler compression to achieve pancreatic parenchyma sealing in a porcine LDP model.
authors.affiliation: Department of General Surgery, Hospital del Mar, Paseo Maritimo 25-28, 08003, Barcelona, Spain, 97485@parcdesalutmar.cat.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Dorcaratto
authors.forename: Fernando
authors.initials: F
authors.lastname: Burdío
authors.forename: Dolors
authors.initials: D
authors.lastname: Fondevila
authors.forename: Anna
authors.initials: A
authors.lastname: Andaluz
authors.forename: Rita
authors.initials: R
authors.lastname: Quesada
authors.forename: Ignasi
authors.initials: I
authors.lastname: Poves
authors.forename: Marta
authors.initials: M
authors.lastname: Caceres
authors.forename: Xavier
authors.initials: X
authors.lastname: Mayol
authors.forename: Enrique
authors.initials: E
authors.lastname: Berjano
authors.forename: Luis
authors.initials: L
authors.lastname: Grande
mesh_terms: D000681:Amylases / Q000032:analysis; D000818:Animals; D001202:Ascitic Fluid / Q000737:chemistry / Q000201:enzymology; D001786:Blood Glucose / Q000032:analysis; D017115:Catheter Ablation; D015850:Interleukin-6 / Q000032:analysis; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000379:methods*; D061646:Operative Time; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology* / Q000517:prevention & control; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D017792:Surgical Stapling; D034421:Sus scrofa; D013552:Swine
chemical_list: D001786:Blood Glucose; D015850:Interleukin-6; D000681:Amylases