Journal of Gastrointestinal Surgery

, Volume 18, Issue 2, pp 411–413

Application of a Penrose Drain Guide for Vascular Stapling During Hepatic Surgery: How I Do It

How I do it


The use of stapling devices to manage vascular pedicles during hepatic surgery has been a significant advance in the field. However, insertion and application of the stapler in vascular dissection planes can be associated with injury to adjacent structures. We describe a five-step technique using a silicone Penrose drain to aid in the positioning of an endovascular stapling device to obtain vascular control during hepatectomy. The use is described here for hepatic vein management during right hepatectomy. The technique can be also used for other applications when transecting major vessels during major liver surgery. The use of this silicone Penrose-guided endovascular stapler technique is a simple, cost-effective maneuver that can be used to improve control and prevent vascular injury during the division of major vascular structures when performing hepatic surgery.


Hepatectomy Endovascular stapler Hepatic vein Surgical technique Silicone drain Penrose drain 


  1. 1.
    Savlid M, Strand AH, Jansson A, Agustsson T, Soderdahl G, Lundell L, Isaksson B (2013) Transection of the liver parenchyma with an ultrasound dissector or a stapler device: results of a randomized clinical study. World J Surg 37:799–805PubMedCrossRefGoogle Scholar
  2. 2.
    Schemmer P, Friess H, Dervenis C, Schmidt J, Weitz J, Uhl W, Buchler MW (2007). The use of endo-GIA vascular staplers in liver surgery and their potential benefit: a review. Dig Surg 24:300–305PubMedCrossRefGoogle Scholar
  3. 3.
    Voyles CR, Vogel SB (1989). Hepatic resection using stapling devices to control the hepatic veins. Am J Surg 158:459–460PubMedCrossRefGoogle Scholar
  4. 4.
    Schemmer P, Friess H, Hinz U, Mehrabi A, Kraus TW, Z'graggen K, Schmidt J, Uhl W, Buchler MW (2006). Stapler hepatectomy is a safe dissection technique: analysis of 300 patients. World J Surg 30:419–430PubMedCrossRefGoogle Scholar
  5. 5.
    Lin MW, Lee JM, Lee YC (2010). Penrose drain tube as a guide for endostaplers during lobectomy via video-assisted thoracoscopic surgery. Thorac Cardiovasc Surg 58:184–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Covidien (2012) Curved Tip Endo GIA Reloads with Tri-Staple Technology. In: Accessed 01/26 2012.

Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Department of SurgeryThe Johns Hopkins HospitalBaltimoreUSA

Personalised recommendations