Radiofrequency-induced heating versus mechanical stapler for pancreatic stump closure: in vivo comparative study

Abstract

Purpose: The aim of this study was to assess the capacity of two methods of surgical pancreatic stump closure in terms of reducing the risk of pancreatic fistula formation (POPF): radiofrequency-induced heating versus mechanical stapler. Materials and methods: Sixteen pigs underwent a laparoscopic transection of the neck of the pancreas. Pancreatic anastomosis was always avoided in order to work with an experimental model prone to POPF. Pancreatic stump closure was conducted either by stapler (ST group, n = 8) or radiofrequency energy (RF group, n = 8). Both groups were compared for incidence of POPF and histopathological alterations of the pancreatic remnant. Results: Six animals (75%) in the ST group and one (14%) in the RF group were diagnosed with POPF (p = 0.019). One animal in the RF group and three animals in the ST group had a pseudocyst in close contact with both pancreas stumps. On day 30 post-operation (PO), almost complete atrophy of the exocrine distal pancreas was observed when the main pancreatic duct was efficiently sealed. Conclusions: Our findings suggest that RF-induced heating is more effective at closing the pancreatic stump than mechanical stapler and leads to the complete atrophy of the distal remnant pancreas.

• Duct sealing
• mechanical stapler
• pancreatectomy
• radiofrequency-assisted resection
• stump closure

Declaration of interest

This work was supported by the Spanish ‘Programa Estatal de Investigación, Desarrollo e Innovación Orientada a los Retos de la Sociedad’ under grant TEC2014-52383-C3-R (TEC2014-52383-C3-3-R). F.B., R.Q. and E.B. declare stock ownership in Apeiron Medical S.L., a company that has a license for the patent US 8.303.584.B2, on which the device tested in this study is based. The other authors report no conflict of interests or financial ties to disclose. The authors alone are responsible for the content and writing of the paper.