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. 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. 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. 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.
Abe et al. (Mon,) studied this question.