Evidence map›Paper›PMID 40858836›Full record

ArticleSurgery today2026

Use of a reinforced triple-row stapler with a powered stapling system reduces the occurrence of postoperative pancreatic fistula after distal pancreatectomy.

Shinjiro Kobayashi, Keisuke Ida, Saori Umezawa, Kazunari Nakahara, Keisuke Tateishi, Tomoko Norose, Nobuyuki Ohike, Tsuyoshi Morimoto, Shinya Mikami, Takehito Otsubo

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Article in Surgery today, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Shinjiro KobayashiDepartment of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan. koharubiyori@marianna-u.ac.jp.
Keisuke IdaDepartment of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.
Saori UmezawaDepartment of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.
Kazunari NakaharaDepartment of Gastroenterology, St. Marianna University School of Medicine, Kawasaki, Japan.
Keisuke TateishiDepartment of Gastroenterology, St. Marianna University School of Medicine, Kawasaki, Japan.
Tomoko NoroseDivision of Molecular Pathology, Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan.
Nobuyuki OhikeDivision of Molecular Pathology, Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Japan.
Tsuyoshi MorimotoDepartment of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan.
Shinya MikamiDepartment of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.
Takehito OtsuboDepartment of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeStapled closure is the standard technique for pancreatic resection via distal pancreatectomy (DP). The Signia™ Stapling System allows for adaptive stapling based on real-time tissue resistance. This study aims to investigate whether DP using the Signia™ system could reduce the incidence of clinically relevant post-operative pancreatic fistula (CR-POPF).

methodsWe retrospectively analyzed 53 patients who underwent DP between 2020 and 2025. 26 patients underwent DP using the Signia™ Stapling System (powered stapler group), and 27 patients using a manual stapler (manual stapler group). The primary outcome was the CR-POPF rate.

resultsIn the powered stapler group, 38.5% of patients developed biochemical leakage, but no cases of CR-POPF were observed. In contrast, the manual stapler group had a CR-POPF rate of 18.5% (p = 0.021). A receiver operating characteristic curve was generated to determine the pancreatic thickness threshold predictive of CR-POPF. The calculated cut-off value was 16 mm. In the powered group, there were no cases of CR-POPF even if the pancreatic thickness at the resection line was ≥ 16 mm.

conclusionsThe use of a powered stapler may therefore help reduce the risk of POPF associated with variability in the thickness and hardness of the pancreas during DP.

Indexed as

PancreatectomyPancreatic FistulaPostoperative ComplicationsSurgical StaplersSurgical StaplingAdultAgedFemaleHumansIncidenceMaleMiddle AgedPancreasRetrospective StudiesDistal pancreatectomyPancreatic fistulaPowered stapler

Identifiers

PMID40858836

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.