title: Evaluation of a transection method for distal pancreatectomy: A comparative study on the use of electrosurgical and stapling devices in swine.
abstract: BACKGROUND
  Despite marked improvements in pancreatic surgery, the high incidence of pancreatic fistula and high morbidity after resection persists.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the role of electrosurgical and stapling devices as an alternative to traditional methods of stump closure in an animal model of distal pancreatectomy.
  
  
  METHODS
  Four devices were used for transection of the pancreatic body : a bi-polar thermofusion system attached to an automatic irrigation function (BI, n = 3), a bi-polar tissue sealer (BS, n = 3), an ultrasonic scissor (US, n = 3), and an endoscopic stapling device (ES, n = 3). For each group, burst pressure was tested using an electronic manometer, with a focus on the location (s) of the first disruption (s). Histological examination was performed for the dissected surfaces. The transection line, including staples, was embedded in a polyester resin, and histological examination was performed for these polished sections of the resin.
  
  
  RESULTS
  Pressure was significantly higher for BI (P < 0.01) than that for the other devices. In contrast, thermal denaturation of the pancreas parenchyma was observed at a depth of approximately 1 mm from the dissected portion for BS, while it extended beyond 15 mm for BI. The staple line was the first disruption point for all of ES cases.
  
  
  CONCLUSIONS
  The pellicle of the pancreas is likely to be deficient after a surgical operation. If the pellicle is preserved, the strength of the pellicle may be insufficient for complete closure with high stapling mechanical pressure or the protein coagulation of usually used electrosurgical devices.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Yo-ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.forename: Eiji
authors.initials: E
authors.lastname: Oki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Keishi
authors.initials: K
authors.lastname: Sugimachi
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Koshi
authors.initials: K
authors.lastname: Mimori
authors.forename: Masayuki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D004598:Electrosurgery / Q000295:instrumentation* / Q000379:methods; D005260:Female; D023421:Models, Animal; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy / Q000295:instrumentation* / Q000379:methods*; D010185:Pancreatic Fistula / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D011312:Pressure; D017792:Surgical Stapling / Q000295:instrumentation* / Q000379:methods; D013552:Swine