Novel Device for Pancreaticojejunostomy via a Pure Laparoscopic Approach Goro Honda, MD, PhD, FACS, Masanao Kurata, MD, PhD, Yukihiro Okuda, MD, Shin.

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Novel Device for Pancreaticojejunostomy via a Pure Laparoscopic Approach Goro Honda, MD, PhD, FACS, Masanao Kurata, MD, PhD, Yukihiro Okuda, MD, Shin Kobayashi, MD, Tatsuro Yamaguchi, MD, PhD, Hiroshi Matsumoto, MD, PhD, Daisuke Nakano, MD, Keiichi Takahashi, MD, PhD Journal of the American College of Surgeons Volume 216, Issue 6, Pages e73-e76 (June 2013) DOI: 10.1016/j.jamcollsurg.2013.02.021 Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 1 Haenawa created on the back table. Haenawa is assembled from a 10-cm, 18-Fr catheter, 4 pieces of 4-0 Nespilene sutures with a gently curved long needle, which has been cut to 18 cm, and metal clips as stoppers. Journal of the American College of Surgeons 2013 216, e73-e76DOI: (10.1016/j.jamcollsurg.2013.02.021) Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 2 Well organized sutures of Haenawa after completion of stitching. They have been arranged like guitar strings. The seromuscular layer of the jejunum was stitched from the patient's right side, and then full-thickness pancreas was stitched in the posterior-to-anterior direction. These sutures were performed with the backhanded stitch technique. A short stent tube was placed and fixed at the stump of the main pancreatic duct with a purse-string suture of the pancreatic parenchyma around the main pancreatic duct. Journal of the American College of Surgeons 2013 216, e73-e76DOI: (10.1016/j.jamcollsurg.2013.02.021) Copyright © 2013 American College of Surgeons Terms and Conditions

Figure 3 After completion of pancreaticojejunostomy. The white sponge on the right side of this photo is Securea. Journal of the American College of Surgeons 2013 216, e73-e76DOI: (10.1016/j.jamcollsurg.2013.02.021) Copyright © 2013 American College of Surgeons Terms and Conditions