Sensor-assisted firing execution (SAFE) cut: a quantitatively standardized technique for pancreatic transection in robotic distal pancreatectomy

Abstract Purpose In robotic distal pancreatectomy (RDP), the lack of haptic feedback and delegation of stapler firing to the bedside assistant make compression quality during transection highly operator-dependent. We describe the “SAFE Cut” (Sensor-Assisted Firing Execution) technique, a quantitatively standardized protocol that converts the subjective “wait-and-fire” judgment into an objective, device-guided workflow. Methods A smart stapler displays tissue resistance as nine stratifications across three color-coded Zones (1–1 to 3–3). A mandatory pre-firing wait (immediate to 60 s) was assigned to each segment and re-applied at every incremental firing step. We reviewed 31 consecutive patients undergoing RDP with the SAFE Cut technique, analyzing prospectively recorded Zone observations for all firing steps. Results The protocol was completed without protocol-related conversion, repositioning, or technical failure in all 31 patients (31 of 31); in every case the stapler was operated by a bedside trainee. Median transection time was 13.3 min (8.7–23.0). CR-POPF occurred in 1 patient (3.2%), with no Grade C fistula and no 90-day mortality. Across 1,179 firing steps, Zone 1 occurred in 940 (79.7%) and Zone 2 in 239 (20.3%); Zone 3 never occurred. Because each step advances the stapler to new tissue, consecutive readings sample different segments; the step after a Zone 2 reading displayed Zone 1 in 136 of 239 events (56.9%). Conclusion The SAFE Cut technique is feasible: the Zone-guided protocol was completed in every patient by a bedside trainee, making the previously hidden heterogeneity of tissue resistance quantifiable. This study was not designed to test fistula prevention; the CR-POPF rate was low, but a study of this size cannot establish efficacy, and whether the approach reduces fistula, and whether comparably low rates recur in other cohorts, needs prospective study.