Evaluation of a transection method for distal pancreatectomy: A comparative study on the use of electrosurgical and stapling devices in swine.

Tetsuo Ikeda, Tomohiko Akahoshi, Hirofumi Kawanaka, Hideaki Uchiyama, Yo ichi Yamashita, Masaru Morita, Eiji Oki, Hiroshi Saeki, Keishi Sugimachi, Toru Ikegami, Tomoharu Yoshizumi, Yuji Soejima, Ken Shirabe, Koshi Mimori, Masayuki Watanabe, Makoto Hashizume, Yoshihiko Maehara

Research output: Contribution to journalArticle

Abstract

Despite marked improvements in pancreatic surgery, the high incidence of pancreatic fistula and high morbidity after resection persists. 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. 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. 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. 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.

Original languageEnglish
Pages (from-to)515-522
Number of pages8
JournalFukuoka igaku zasshi = Hukuoka acta medica
Volume104
Issue number12
Publication statusPublished - Jan 1 2013

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Pancreatectomy
Swine
Equipment and Supplies
Pressure
Pancreas
Pancreatic Fistula
Polyesters
Ultrasonics
Animal Models
Hot Temperature
Morbidity
Incidence
Proteins

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Evaluation of a transection method for distal pancreatectomy : A comparative study on the use of electrosurgical and stapling devices in swine. / Ikeda, Tetsuo; Akahoshi, Tomohiko; Kawanaka, Hirofumi; Uchiyama, Hideaki; Yamashita, Yo ichi; Morita, Masaru; Oki, Eiji; Saeki, Hiroshi; Sugimachi, Keishi; Ikegami, Toru; Yoshizumi, Tomoharu; Soejima, Yuji; Shirabe, Ken; Mimori, Koshi; Watanabe, Masayuki; Hashizume, Makoto; Maehara, Yoshihiko.

In: Fukuoka igaku zasshi = Hukuoka acta medica, Vol. 104, No. 12, 01.01.2013, p. 515-522.

Research output: Contribution to journalArticle

Ikeda, T, Akahoshi, T, Kawanaka, H, Uchiyama, H, Yamashita, YI, Morita, M, Oki, E, Saeki, H, Sugimachi, K, Ikegami, T, Yoshizumi, T, Soejima, Y, Shirabe, K, Mimori, K, Watanabe, M, Hashizume, M & Maehara, Y 2013, 'Evaluation of a transection method for distal pancreatectomy: A comparative study on the use of electrosurgical and stapling devices in swine.', Fukuoka igaku zasshi = Hukuoka acta medica, vol. 104, no. 12, pp. 515-522.
Ikeda, Tetsuo ; Akahoshi, Tomohiko ; Kawanaka, Hirofumi ; Uchiyama, Hideaki ; Yamashita, Yo ichi ; Morita, Masaru ; Oki, Eiji ; Saeki, Hiroshi ; Sugimachi, Keishi ; Ikegami, Toru ; Yoshizumi, Tomoharu ; Soejima, Yuji ; Shirabe, Ken ; Mimori, Koshi ; Watanabe, Masayuki ; Hashizume, Makoto ; Maehara, Yoshihiko. / Evaluation of a transection method for distal pancreatectomy : A comparative study on the use of electrosurgical and stapling devices in swine. In: Fukuoka igaku zasshi = Hukuoka acta medica. 2013 ; Vol. 104, No. 12. pp. 515-522.
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abstract = "Despite marked improvements in pancreatic surgery, the high incidence of pancreatic fistula and high morbidity after resection persists. 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. 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. 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. 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.",
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AU - Kawanaka, Hirofumi

AU - Uchiyama, Hideaki

AU - Yamashita, Yo ichi

AU - Morita, Masaru

AU - Oki, Eiji

AU - Saeki, Hiroshi

AU - Sugimachi, Keishi

AU - Ikegami, Toru

AU - Yoshizumi, Tomoharu

AU - Soejima, Yuji

AU - Shirabe, Ken

AU - Mimori, Koshi

AU - Watanabe, Masayuki

AU - Hashizume, Makoto

AU - Maehara, Yoshihiko

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N2 - Despite marked improvements in pancreatic surgery, the high incidence of pancreatic fistula and high morbidity after resection persists. 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. 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. 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. 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.

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