Comparison of ultrasonically activated scalpel versus conventional division for the pancreas in distal pancreatectomy

Sugo, Hiroyuki; Mikami, Youshi; Matsumoto, Fumio; Tsumura, Hidenori; Watanabe, Yozo; Futagawa, Shunji

doi:10.1007/s005340170007

Cited by 48 publications

(47 citation statements)

References 12 publications

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“…In this study, we support that DP can be performed with low perioperative mortality (1.5%), while the incidence of pancreatic fistula, which was the most common postoperative complication, was 22%. These results are in accordance with the most authors' conclusions [3,4,[7][8][9] . In the past, in most of published studies there was no definition of pancreatic fistula and the diagnostic criteria for this had not yet been completely established.…”

Section: Discussionsupporting

confidence: 93%

“…In almost all of them, we had no difficulty to find out the pancreatic duct. However, there was no significant difference according to the incidence of pancreatic fistula in our study in comparison with the literature studies [3,4,[7][8][9] . Many authors state that the texture of the pancreatic parenchyma seems generally to be one of the most important risk factors responsible for the increased rate of pancreatic fistula [2,9] .…”

Section: T a B L E 4 I N C I D E N C E O F P A N C R E A T I C F I S contrasting

confidence: 84%

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Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

Ridolfini

Alfieri²,

Gourgiotis³

et al. 2007

WJG

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AIM:To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump. METHODS:Sixty-four patients underwent DP during a 10-year period. Information regarding diagnosis, operative details, and perioperative morbidity or mortality was collected. Eight risk factors were examined. RESULTS:Indications for DP included primary pancreatic disease (n = 38, 59%) and non-pancreatic malignancy (n = 26, 41%). Postoperative mortality and morbidity rates were 1.5% and 37% respectively; one patient died due to sepsis and two patients required a reoperation due to postoperative bleeding. Pancreatic fistula was developed in 14 patients (22%); 4 of fistulas were classified as Grade A, 9 as Grade B and only 1 as Grade C. Incidence of pancreatic fistula rate was significantly associated with four risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, and texture of pancreatic parenchyma. The role that technique (either stapler or suture) of pancreatic stump closure plays in the development of pancreatic leak remains unclear. CONCLUSION:The pancreatic fistula rate after DP is 22%. This is reduced for patients with non-pancreatic malignancy, fibrotic pancreatic tissue, postoperative prophylactic octreotide therapy and concomitant splenectomy.

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Section: Discussionsupporting

confidence: 93%

Section: T a B L E 4 I N C I D E N C E O F P A N C R E A T I C F I S contrasting

confidence: 84%

Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

Ridolfini

Alfieri²,

Gourgiotis³

et al. 2007

WJG

View full text Add to dashboard Cite

show abstract

“…This underscores the early experiences made with the LigaSure device in pancreatic surgery that showed no difference in mortality between study groups [13,34,35]. The present study cannot confirm the previous suggestion that dividing the pancreas with an ultrasonic dissection device during distal pancreatectomy reduces the incidence of pancreatic fistula [16,17] since fistula rates were comparable in both groups. Postoperative hospital stay was not different between the groups.…”

Section: Discussioncontrasting

confidence: 55%

“…Some studies have also demonstrated reduced operative time in thyroid surgery [12] and a trend towards decreased blood loss and less need for perioperative transfusion of blood erythrocyte concentrates [13][14][15]. It has also been suggested that dividing the pancreas with the ultrasonic dissection device during distal pancreatectomy reduces the incidence of pancreatic fistula [16,17]. However, there has only been one small-scale pilot study of 14 patients which compared the results of the vessel-sealing LigaSure with conventional dissection techniques in partial pancreaticoduodenectomy.…”

Section: Introductionmentioning

confidence: 99%

Harmonic Scalpel versus Conventional Dissection Technique in Pylorus-Preserving Partial Duodenopancreatectomy

et al. 2012

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Background/Aims: Pancreatic head resection is performed with low mortality, but morbidity remains high. Extensive preparation, long operating times, intraoperative blood loss and the need for blood transfusions are risk factors for postoperative morbidity. The aim of our study was to evaluate the feasibility and safety of the ultrasonic dissection device in pylorus-preserving duodenopancreatectomy (PPPD). Methods: Fifty consecutive patients who underwent PPPD with an ultrasonic dissection device (group 1) were compared with a match-controlled group of 50 consecutive patients who underwent PPPD with conventional dissection techniques (group 2). Duration of surgery, intraoperative blood loss, blood units, complications, mortality and duration of hospital stay were analyzed. Results: There was no difference in age, gender or BMI between groups. In group 1, mean blood loss (446 ± 281.8 ml, p = 0.008) and number of blood units (0.32 ± 0.86, p = 0.001) were significantly lower than in group 2 (819 ± 915.4 ml; 1.36 ± 2.83 units). Duration of surgery was shorter in group 1 (345.6 vs. 373 min, p = 0.28). The rate of postoperative complications, mortality and hospital stay were not significantly different. Conclusions: Use of an ultrasonic dissection device in PPPD might significantly reduce intraoperative blood loss and the need for blood transfusions. These results should be verified in a prospective randomized controlled trial.

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“…It has been claimed that the use of the harmonic scalpel decrease operative time, complications and bleeding in abdominal surgery [5,6], thoracic surgery [7], parotids surgery [8] and thyroid surgery [9,10].…”

Section: Introductionmentioning

confidence: 99%

Use of the harmonic scalpel versus conventional haemostatic techniques in patients with Grave disease undergoing total thyroidectomy: a prospective randomised controlled trial

Hallgrimsson

Lovén

Westerdahl

et al. 2008

Langenbecks Arch Surg

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Comparison of ultrasonically activated scalpel versus conventional division for the pancreas in distal pancreatectomy

Abstract: The use of the ultrasonically activated scalpel was found to reduce the incidence of pancreatic fistula in distal pancreatectomy. Furthermore, the use of this device without any clamping or parenchymal suturing may reduce the damage to the remnant pancreas.

Cited by 48 publications

References 12 publications

Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

Harmonic Scalpel versus Conventional Dissection Technique in Pylorus-Preserving Partial Duodenopancreatectomy

Use of the harmonic scalpel versus conventional haemostatic techniques in patients with Grave disease undergoing total thyroidectomy: a prospective randomised controlled trial

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