As previously described [3 (link),4 (link)], to safely transect the pancreas during laparoscopy, we used endoscopic linear staplers of various heights, depending on the thickness or hardness of the pancreas. Two endoscopic stapler cartridges, Echelon Endopath (Ethicon Endosurgery, Cincinnati, OH, USA) and EndoGIA™ 60-mm Reload with Tri-Staple™ Technology (Covidien Medtronic, Plymouth, MN, USA), included (i) a regular-height cartridge (3.8-mm gold Echelon Endopath or 3- to 4-mm purple EndoGIA™ 60-mm Reload with Tri-Staple™ Technology), (ii) a long-height cartridge (4.1-mm green Echelon Endopath or 4- to 5-mm black EndoGIA™ 60-mm Reload with Tri-Staple™ Technology), and (iii) a short-height cartridge (3.5-mm blue Echelon Endopath).
In most cases, after transecting the pancreas, the pancreatic remnant was covered with a fibrinogen-coated and thrombin-coated collagen sponge (TachoComb or TachoSil; Nycomed GmbH, Konstanz, Germany) or a polyglycolic acid felt (Neoveil®) and fibrin sealant (Tissucol; Baxter GmbH, Unterschleissheim, Germany).
In most cases, after transecting the pancreas, the pancreatic remnant was covered with a fibrinogen-coated and thrombin-coated collagen sponge (TachoComb or TachoSil; Nycomed GmbH, Konstanz, Germany) or a polyglycolic acid felt (Neoveil®) and fibrin sealant (Tissucol; Baxter GmbH, Unterschleissheim, Germany).