Pancreatic resection with ultrasonically activated scalpel: preliminary observations

Resection of the pancreas was performed with a surgical knife, electrocautery, or an automatic stapler. We histologically and radiologically evaluated the applicability of the ultrasonically activated scalpel (Coagulating Shears, CS, Ethicon Endo-Surgery, Cincinnati, OH, USA) for resecting pancreatic parenchyma and reported our clinical observations on the use of the coagulating shears.

Resection of the pancreas was performed with the coagulating shears in 8 patients and with electrocautery in 5. The pancreas was transected with blunt mode of the coagulating shears at output power level of 3. Histologic thermal degeneration of the surface was evaluated with hematoxylin-eosin and Azan-Mallory staining. Radiologic pancreaticography was carried out on 4 resected specimens. We report 8 practical applications of the coagulating shears and compared its use with that of electrocautery in pancreatic surgery.

Histologically, a coagulum of degenerated tissue completely closed each end of the vessels in the transected surface of all cases. The mean breadth of thermal degeneration resulting from the use of the coagulating shears was significantly less than that caused by electrocautery (1.33 +/- 0.21 vs. 3.05 +/- 0.34 mm, respectively) Pancreaticograms showed the closed branches of the pancreatic duct, but the closed main pancreatic duct had burst in 1 of 4 cases. Clinically, pancreatic fistula occurred in 1 of 8 patients who underwent pancreatic surgery with the coagulating shears.

Pancreatic resection with the coagulating shears might be effective and feasible as long as the main pancreatic duct is ligated.