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Background <p>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.</p> Methods <p>In this prospective study of 44 consecutive RDP patients (March 2020–September 2025), outcomes were compared between a quadruple reinforcement group (<i>n</i> = 27) and a control group (<i>n</i> = 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.</p> Results <p>Pancreatic texture was comparable between the groups. The quadruple reinforcement group demonstrated a significantly lower incidence of CR-POPF (3.7% vs. 41.2%, <i>P</i> = 0.002) and fewer complications ≥ Clavien-Dindo grade IIIa (0% vs. 23.5%, <i>P</i> = 0.004) compared to controls. Median hospital stay was significantly shorter in the reinforcement group (5.0 vs. 7.0&#xa0;days, <i>P</i> = 0.007). There were no 30-day reoperations or 90-day mortalities in either group.</p> Conclusions <p>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.</p>

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Quadruple reinforcement technique for pancreatic stump during robotic distal pancreatectomy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月30日

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  • Satoru Abe,
  • Yoshikuni Kawaguchi,
  • Kyoji Ito,
  • Sho Kiritani,
  • Yusuke Kazami,
  • Yujiro Nishioka,
  • Akihiko Ichida,
  • Takeshi Takamoto,
  • Kiyoshi Hasegawa

摘要

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.