Related Experiment Video
Updated: May 23, 2026
Modified Single-Loop Reconstruction for Pancreaticoduodenectomy
Published on: September 28, 2019
Video-based assessment identifies intraoperative predictors of clinically relevant POPF following minimally invasive
Laleh Foroutani1, Pietro Mascagni1,2, Amir Ashraf Ganjouei1
1Department of Surgery, University of California, San Francisco, San Francisco, CA, USA.
Background:
Clinically relevant postoperative pancreatic fistula (CR-POPF) is the most consequential complication after distal pancreatectomy, occurring in up to one-third of cases. Video-based assessment (VBA) captures technical details not documented in operative reports. We conducted a VBA study to evaluate intraoperative factors associated with CR-POPF.
Methods:
We performed a retrospective single-center study of adults undergoing laparoscopic or robotic distal pancreatectomy (2019-2024). Three blinded reviewers coded predefined intraoperative variables from operative videos during the pancreatic transection. Associations with CR-POPF were assessed using Firth penalized logistic regression.
Results:
Among 43 patients, 11 (25.6%) developed CR-POPF. Patients with CR-POPF were younger (median 46 vs. 59 years, p < 0.05) and more often non-white (27% vs. 63%, p < 0.05). Intraoperatively, coarse stapler movement (73% vs. 25%, p < 0.05) and capsular fracture (73% vs. 19%, p < 0.05) were significantly associated with CR-POPF. Rotational movement, short compression time, and stapler line bleeding trended toward significance. Clip application for hemostasis showed a non-significant protective effect. On regression analysis, capsular fracture predicted CR-POPF (OR = 6.47, p = 0.03), and coarse stapler movement trended toward significance (OR = 9.22, p = 0.06).
Conclusion:
VBA identified capsular fracture as a significant predictor of CR-POPF and stapler movement as a modifiable factor. Larger multicenter studies are warranted to validate findings and guide technical training.
