Impact of the stapler method on postoperative pancreatic fistula in robot-assisted pancreaticoduodenectomy: a retrospective study.

Background: Postoperative pancreatic fistula (POPF) remains a significant complication after pancreaticoduodenectomy. However, optimal techniques for pancreatic transection to minimize the risk of POPF have not been thoroughly elucidated. This study aimed to evaluate the impact of stapler-assisted pancreatic transection and reconstruction (stapler method) on the incidence of clinically relevant POPF (CR-POPF) and to present the technical details of the stapler method, accompanied by supplementary video footage.

Methods: A retrospective review was conducted on patients who underwent robot-assisted pancreaticoduodenectomy (RPD) between October 2020 and December 2024. Patients were categorized into the stapler method group and the conventional method group, in which pancreatic transection was performed using a coagulation-based technique. The incidence and risk factors for CR-POPF were analyzed, and post-pancreatectomy acute pancreatitis (PPAP) was also evaluated.

Results: A total of 134 patients who underwent RPD were included in this study, with 61 in the stapler method group and 73 in the conventional method group. The incidence of CR-POPF was significantly lower in the stapler method group compared to the conventional method group (13.1% vs. 31.5%, p = 0.014). In multivariate analysis, body mass index was independently associated with an increased risk of CR-POPF (OR, 1.34; 95% CI, 1.14-1.57; p < 0.001), while the stapler method was associated with a significantly reduced risk (OR, 0.31; 95% CI, 0.12-0.80; p = 0.016). Although postoperative serum amylase levels on postoperative day 1 were significantly higher in the stapler method group (578 U/L; IQR, 292-1107) than in the conventional method group (336 U/L; IQR, 242-830; p = 0.020), the incidence of PPAP did not significantly differ between the groups (stapler method: 1.6% vs. conventional method: 1.4%, p = 1.000).

Conclusions: These findings suggest that the stapler method may reduce the incidence of CR-POPF in RPD without increasing the risk of PPAP.