Laparoscopic clamp-crushing enucleation with a pancreatic duct stent for tumors located close to the main pancreatic duct

Sakamoto, Katsunori; Ogawa, Kohei; Takai, Akira; Tamura, Kazutoshi; Iwata, Miku; Ito, Chihiro; Sakamoto, Akimasa; Matsui, Takashi; Nishi, Yusuke; Uraoka, Mio; Nagaoka, Tomoyuki; Funamizu, Naotake; Takada, Yasutsugu

doi:10.1007/s00595-021-02428-w

Cited by 6 publications

(8 citation statements)

References 19 publications

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“…14,15 Therefore, pancreatic parenchymal dissection using the clamp-crushing technique might be easily adopted by surgeons who are familiar with robotic hepato-pancreato-biliary surgery. 8 As shown in the video (Supplemental Video, Supplemental Digital Content 1, http://links.lww.com/SLE/A413), this procedure can preserve narrow vessels for clipping and it maintains a dry operative field. In addition, it enables identification of the MPD by laparoscopy enhanced view in the case of a narrow MPD.…”

Section: Discussionmentioning

confidence: 99%

“…Clamp-crushing parenchymal dissection is reportedly useful in laparoscopic hepatectomy and is also the main method in robotic hepatectomy 14,15 . Therefore, pancreatic parenchymal dissection using the clamp-crushing technique might be easily adopted by surgeons who are familiar with robotic hepato-pancreato-biliary surgery 8 . As shown in the video (Supplemental Video, Supplemental Digital Content 1, http://links.lww.com/SLE/A413), this procedure can preserve narrow vessels for clipping and it maintains a dry operative field.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] However, pancreatic transection by linear stapler is less suitable for tumors in the pancreatic body and above the portal vein, as this method reduces the width of the surgical margin. 8 Therefore, in a limited number of cases, a method of pancreatic transection that can achieve a wider surgical margin than that of stapler transection is sometimes required. 8 In such cases, it would be preferable to obtain a sufficient and exact surgical margin by pancreatic parenchymal transection in small increments, using a dedicated device.…”

mentioning

confidence: 99%

“…8 Therefore, in a limited number of cases, a method of pancreatic transection that can achieve a wider surgical margin than that of stapler transection is sometimes required. 8 In such cases, it would be preferable to obtain a sufficient and exact surgical margin by pancreatic parenchymal transection in small increments, using a dedicated device. However, the treatment of the pancreatic stump and pancreatic duct is a major issue in pancreatic transection methods that do not use a stapler because improper treatment can cause severe POPF.…”

mentioning

confidence: 99%

“…Reinforced linear staplers have also had a positive impact and have recently become widely used for pancreatic transection as they can prevent postoperative pancreatic fistula (POPF) 4–6 . However, pancreatic transection by linear stapler is less suitable for tumors in the pancreatic body and above the portal vein, as this method reduces the width of the surgical margin 8 . Therefore, in a limited number of cases, a method of pancreatic transection that can achieve a wider surgical margin than that of stapler transection is sometimes required 8 .…”

mentioning

confidence: 99%

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Clamp-crushing Pancreatic Transection in Minimally Invasive Distal Pancreatectomy

Sakamoto,

Ogawa,

Tamura

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Minimally invasive distal pancreatectomy has become a widely accepted procedure for tumors located in the pancreatic body or tail. However, pancreatic transection by linear stapler is generally avoided for pancreatic body tumors located above the portal vein because the surgical margin width is narrowed after taking into account the cutting allowance for insertion of the stapling device. Herein, we report a parenchymal clamp-crushing procedure that provides a sufficient surgical margin in pancreatic transection. Methods: Two patients with suspected early pancreatic cancer underwent pancreatic transection using the clamp-crushing procedure. The planned pancreatic transection line was set just to the left of the gastroduodenal artery in both cases. Robotic and laparoscopic distal pancreatectomy were performed in 1 patient each. Patients were positioned supine with split legs. Parenchymal transection was performed with crushing by VIO 3 (ERBE Elektromedizin) operated in softCOAG Bipolar mode with Effect 2/modulation 50. After crushing, remnant tissue was cut in autoCUT Bipolar mode operated by VIO 3 with Effect 2/modulation 50, or cut after secured by clipping. Results: The surgical duration was 253 and 212 minutes, and estimated blood loss was 0 and 50 mL in the 2 patients, and both were discharged with uneventful courses. Pathologic examination confirmed a negative surgical margin in both patients. Conclusion: Clamp-crushing pancreatic transection for distal pancreatectomy might be a suitable treatment option for achieving sufficient surgical margin in pancreatic body tumors located close to the portal vein.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%