Comparison of Different Surgical Techniques in Distal Pancreatectomy

Gehrig, Tobias; Fonouni, Hamid; Müller‐Stich, Beat P.; Golriz, Mohammad; Abbassi, Sepehr; Nickel, Felix; Esmaeilzadeh, Majid; Brand, Karsten; Rad, Morva Tahmasbi; Hughes, Katherine M.; Hinz, Ulf; Büchler, Markus W.; Gutt, Carsten N.; Mehrabi, Arianeb

doi:10.1177/1553350610395032

Cited by 13 publications

(11 citation statements)

References 24 publications

(22 reference statements)

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“…Advantage of suturing is its availability and low cost. However, it is time-consuming and technically not feasible on soft, fragile pancreas parenchyma and is challenging laparoscopically [27]. Reported POPF rates have a wide spectrum (9-61%), which is partially due to non-standardized fistula definitions and different, additionally used methods in various studies [17,30].…”

Section: Closure Of the Pancreatic Remnantmentioning

confidence: 99%

A Review of Techniques for Closure of the Pancreatic Remnant following Distal Pancreatectomy

et al. 2016

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The prevalence of pancreatic diseases needing surgical intervention is continuously rising. Distal pancreatectomy is performed in the case of pathologies affecting the left side of the pancreas. More and more sophisticated surgical techniques have appeared and an increasing number of published articles discuss the possibilities for closure of the pancreatic remnant. However, the optimum solution is still under debate, as none of the examined techniques have been proven superior in reducing the incidence of the most common surgical complication, the formation of a postoperative pancreatic fistula (PF). Fistula rates have been stationary at 20-30% in the past decades despite the apparent advancement of medicine. This review presents a survey of the relevant articles examining different closure strategies and risk factors to reduce fistula formation rate. International medical publication database search and assessment was carried out to include the findings of studies investigating the efficacy of pancreatic remnant closure techniques to gain a clearer view on the complexity of pancreas fistulas. Emphasis is on indications for surgery, risk factors for postoperative fistula formation and strategies to seal the pancreatic remnant to avoid leakage. Findings suggest that careful patient selection, meticulous surgical techniques are equally important to reduce fistula rates. Ideal closure of the pancreatic remnant is still to be developed, as none of the widespread techniques (hand-sewn suture or staple closure) proved to be statistically significantly superior. Additional closure and covering methods (seromuscular patch, falciform ligament patch, pancreatico-enteric anastomosis, reinforced staplers, fibrin glue etc.) can have profitable effect but strong evidences are yet to come due to small case numbers. The recent introduction of standardized classification of PFs and future prospective randomized trials are more likely to be susceptible to determine if any of the standard or experimental closure techniques is more beneficial than the others.

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Section: Closure Of the Pancreatic Remnantmentioning

confidence: 99%

A Review of Techniques for Closure of the Pancreatic Remnant following Distal Pancreatectomy

et al. 2016

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“…Other techniques have been examined as a device is given a novel application in distal pancreatectomy. For example, ultrasonic dissection in nonfibrotic pancreas (soft and without ductal dilatation) has been shown to be superior to scalpel division and suture closure in one randomized clinical trial [ 16 ], and transection using Ligasure is as effective as scalpel and suture closure in porcine models [ 17 , 18 ]. Others have successfully reduced POPF incidence with the use of bipolar scissors to transect pancreas compared to conventional methods [ 19 ], and still another retrospective review suggests electrocautery with oversewing has the lowest rates of complication compared to scalpel division or stapling [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

The Use of Bovine Pericardial Buttress on Linear Stapler Fails to Reduce Pancreatic Fistula Incidence in a Porcine Pancreatic Transection Model

et al. 2011

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We investigate the effectiveness of buttressing the surgical stapler to reduce postoperative pancreatic fistulae in a porcine model. As a pilot study, pigs (n = 6) underwent laparoscopic distal pancreatectomy using a standard stapler. Daily drain output and lipase were measured postoperative day 5 and 14. In a second study, pancreatic transection was performed to occlude the proximal and distal duct at the pancreatic neck using a standard stapler (n = 6), or stapler with bovine pericardial strip buttress (n = 6). Results. In pilot study, 3/6 animals had drain lipase greater than 3x serum on day 14. In the second series, drain volumes were not significantly different between buttressed and control groups on day 5 (55.3 ± 31.6 and 29.3 ± 14.2 cc, resp.), nor on day 14 (9.5 ± 4.2 cc and 2.5 ± 0.8 cc, resp., P = 0.13). Drain lipase was not statistically significant on day 5 (3,166 ± 1,433 and 6,063 ± 1,872 U/L, resp., P = 0.25) or day 14 (924 ± 541 and 360 ± 250 U/L). By definition, 3/6 developed pancreatic fistula; only one (control) demonstrating a contained collection arising from the staple line. Conclusion. Buttressed stapler failed to protect against pancreatic fistula in this rigorous surgical model.

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“…All animals used in the experimental laboratory were managed according to German laws for animal use and care, and according to the directives of the European Community Council (2010/63/EU) and ARRIVE guidelines 64 . Regular pigs (Sus scrofa domesticus) with a mean weight of 35 kg were chosen as model organism 4,[65][66][67][68] . Data from 46 pigs was included in the analyses.…”

Section: Methodsmentioning

confidence: 99%

Spectral organ fingerprints for machine learning-based intraoperative tissue classification with hyperspectral imaging in a porcine model

Studier-Fischer

Seidlitz

Sellner

et al. 2022

Sci Rep

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Visual discrimination of tissue during surgery can be challenging since different tissues appear similar to the human eye. Hyperspectral imaging (HSI) removes this limitation by associating each pixel with high-dimensional spectral information. While previous work has shown its general potential to discriminate tissue, clinical translation has been limited due to the method’s current lack of robustness and generalizability. Specifically, the scientific community is lacking a comprehensive spectral tissue atlas, and it is unknown whether variability in spectral reflectance is primarily explained by tissue type rather than the recorded individual or specific acquisition conditions. The contribution of this work is threefold: (1) Based on an annotated medical HSI data set (9059 images from 46 pigs), we present a tissue atlas featuring spectral fingerprints of 20 different porcine organs and tissue types. (2) Using the principle of mixed model analysis, we show that the greatest source of variability related to HSI images is the organ under observation. (3) We show that HSI-based fully-automatic tissue differentiation of 20 organ classes with deep neural networks is possible with high accuracy (> 95%). We conclude from our study that automatic tissue discrimination based on HSI data is feasible and could thus aid in intraoperative decisionmaking and pave the way for context-aware computer-assisted surgery systems and autonomous robotics.

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Comparison of Different Surgical Techniques in Distal Pancreatectomy

Abstract: In the present experimental animal study, LigaSure seems to be fast and safe as well as comparable with the standard transection and closure techniques in DP.

Cited by 13 publications

References 24 publications

A Review of Techniques for Closure of the Pancreatic Remnant following Distal Pancreatectomy

A Review of Techniques for Closure of the Pancreatic Remnant following Distal Pancreatectomy

The Use of Bovine Pericardial Buttress on Linear Stapler Fails to Reduce Pancreatic Fistula Incidence in a Porcine Pancreatic Transection Model

Spectral organ fingerprints for machine learning-based intraoperative tissue classification with hyperspectral imaging in a porcine model

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