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Updated: Jun 9, 2026
Application of End-to-end Anastomosis in Robotic Central Pancreatectomy
Published on: June 2, 2018
Quadruple reinforcement technique for pancreatic stump during robotic distal pancreatectomy
Satoru Abe1, Yoshikuni Kawaguchi2,3, Kyoji Ito1,4
1Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Background:
Postoperative pancreatic fistula (POPF) remains a significant challenge in robotic distal pancreatectomy (RDP). We developed a novel "quadruple reinforcement technique" to mitigate this risk and evaluated its clinical efficacy compared to conventional techniques.
Methods:
In this prospective study of 44 consecutive RDP patients (March 2020-September 2025), outcomes were compared between a quadruple reinforcement group (n = 27) and a control group (n = 17). The reinforcement technique involved: (1) staple line reinforcement; (2) absorbable reinforcement felt; (3) U-shaped sutures using a 3-0 non-absorbable double-armed monofilament; and (4) sprayed fibrin sealant. Clinically relevant POPF (CR-POPF) was defined per 2016 ISGPS criteria.
Results:
Pancreatic texture was comparable between the groups. The quadruple reinforcement group demonstrated a significantly lower incidence of CR-POPF (3.7% vs. 41.2%, P = 0.002) and fewer complications ≥ Clavien-Dindo grade IIIa (0% vs. 23.5%, P = 0.004) compared to controls. Median hospital stay was significantly shorter in the reinforcement group (5.0 vs. 7.0 days, P = 0.007). There were no 30-day reoperations or 90-day mortalities in either group.
Conclusions:
The quadruple reinforcement technique is a safe and feasible strategy that significantly reduces CR-POPF and major complications. This systematic combination effectively optimizes postoperative outcomes in RDP.
