Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy
Background Although the artery-first approach is widely used in open pancreaticoduodenectomy, it is difficult to laparoscopically expose the origin of the inferior pancreaticoduodenal artery (IPDA) from the left side of the superior mesenteric artery (SMA). By contrast, damaging the inferior pancrea...
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| creator | Nagakawa, Yuichi Hosokawa, Yuichi Sahara, Yatsuka Takishita, Chie Hijikata, Yosuke Osakabe, Hiroaki Nakajima, Tetsushi Shirota, Tomoki Katsumata, Kenji Nakamura, Masafumi Tsuchida, Akihiko |
| description | Background
Although the artery-first approach is widely used in open pancreaticoduodenectomy, it is difficult to laparoscopically expose the origin of the inferior pancreaticoduodenal artery (IPDA) from the left side of the superior mesenteric artery (SMA). By contrast, damaging the inferior pancreaticoduodenal veins (IPDVs) is possible when approaching the IPDA from the right side of the SMA. To facilitate the artery-first approach in laparoscopic pancreaticoduodenectomy (LPD), we focused on the proximal-dorsal jejunal vein (PDJV) that branched from the superior mesenteric vein (SMV) dorsal side and drained the IPDVs. This study aimed to clarify the usefulness of the right SMA approach using the PDJV preisolation method.
Methods
The PDJV was first isolated, and the IPDVs were divided along the PDJV on the right side of the SMA. Then, the IPDA was divided at the root without first separating the pancreatic head from the portal vein and the SMV. Overall, 21 patients underwent this approach, and the results were retrospectively compared with those of 21 patients who underwent the artery-first approach, which was performed on the left side of the SMA. Anatomical characteristics of the PDJV were evaluated using multidetector computed tomography for the two groups.
Results
Operative times and resection times were significantly lower for the PDJV preisolation group than for the conventional LPD group (489.3 vs. 541.7 min, respectively;
p
= 0.002). During anatomical evaluation, 41 patients (97.6%) had a PDJV that drained from the SMV dorsally and was in contact with the anterior aspect of the uncinate process. The PDJV was confirmed as the first jejunal vein in 31 patients (73.8%) and as the second jejunal vein in 10 patients (23.8%).
Conclusions
This approach facilitates dissection of the IPDA on the right side of the SMA, thereby reducing operative times. |
| doi_str_mv | 10.1007/s00464-018-6118-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2008889801</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2008197439</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-3cf7379991e5859e77aeb95d487407f5c5b07b8de3c67de352804593a1d496c23</originalsourceid><addsrcrecordid>eNp1kc9u1DAQxi0EotvCA3BBkbhwCfjv2j5WVaFIlbjA2fLak25WSRzsGLF9H96TWdKChMRlxpJ_3zea-Qh5xeg7Rql-XyiVW9lSZtotw3L_hGyYFLzlnJmnZEOtoC3XVp6R81IOFHHL1HNyxq00UimxIT8v5zknH_b9dNcse2hKnSH3KTcjFJgWfIfGZ-zHpstp_M3k_m6_NKWP0NTyKESbH_3ohzamXPzQHOBQJ-zfoZ_wE_qSBr_0aULnZZ9iE2s-aQc_-5xKSDNOmv0UMiAWUqwpwgRhSePxBXnW-aHAy4d-Qb5-uP5yddPefv746erytg1SmKUVodNCW2sZKKMsaO1hZ1WURkuqOxXUjuqdiSDCVmNV3FCprPAsSrsNXFyQt6svLvOtQlnc2JcAw-AnSLU4TqkxxhrKEH3zD3pINePCK8WslsIixVYq4IolQ-fmjEfKR8eoO2Xo1gwdZuhOGbp71Lx-cK67EeIfxWNoCPAVKPPpgpD_jv6_6y87KKv4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2008197439</pqid></control><display><type>article</type><title>Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy</title><source>Springer Nature - Complete Springer Journals</source><creator>Nagakawa, Yuichi ; Hosokawa, Yuichi ; Sahara, Yatsuka ; Takishita, Chie ; Hijikata, Yosuke ; Osakabe, Hiroaki ; Nakajima, Tetsushi ; Shirota, Tomoki ; Katsumata, Kenji ; Nakamura, Masafumi ; Tsuchida, Akihiko</creator><creatorcontrib>Nagakawa, Yuichi ; Hosokawa, Yuichi ; Sahara, Yatsuka ; Takishita, Chie ; Hijikata, Yosuke ; Osakabe, Hiroaki ; Nakajima, Tetsushi ; Shirota, Tomoki ; Katsumata, Kenji ; Nakamura, Masafumi ; Tsuchida, Akihiko</creatorcontrib><description>Background
Although the artery-first approach is widely used in open pancreaticoduodenectomy, it is difficult to laparoscopically expose the origin of the inferior pancreaticoduodenal artery (IPDA) from the left side of the superior mesenteric artery (SMA). By contrast, damaging the inferior pancreaticoduodenal veins (IPDVs) is possible when approaching the IPDA from the right side of the SMA. To facilitate the artery-first approach in laparoscopic pancreaticoduodenectomy (LPD), we focused on the proximal-dorsal jejunal vein (PDJV) that branched from the superior mesenteric vein (SMV) dorsal side and drained the IPDVs. This study aimed to clarify the usefulness of the right SMA approach using the PDJV preisolation method.
Methods
The PDJV was first isolated, and the IPDVs were divided along the PDJV on the right side of the SMA. Then, the IPDA was divided at the root without first separating the pancreatic head from the portal vein and the SMV. Overall, 21 patients underwent this approach, and the results were retrospectively compared with those of 21 patients who underwent the artery-first approach, which was performed on the left side of the SMA. Anatomical characteristics of the PDJV were evaluated using multidetector computed tomography for the two groups.
Results
Operative times and resection times were significantly lower for the PDJV preisolation group than for the conventional LPD group (489.3 vs. 541.7 min, respectively;
p
= 0.002). During anatomical evaluation, 41 patients (97.6%) had a PDJV that drained from the SMV dorsally and was in contact with the anterior aspect of the uncinate process. The PDJV was confirmed as the first jejunal vein in 31 patients (73.8%) and as the second jejunal vein in 10 patients (23.8%).
Conclusions
This approach facilitates dissection of the IPDA on the right side of the SMA, thereby reducing operative times.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-018-6118-z</identifier><identifier>PMID: 29484553</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Gastroenterology ; Gynecology ; Hepatology ; Laparoscopy ; Medicine ; Medicine & Public Health ; New Technology ; Pancreatic cancer ; Pancreaticoduodenectomy ; Proctology ; Surgery ; Veins & arteries</subject><ispartof>Surgical endoscopy, 2018-09, Vol.32 (9), p.4044-4051</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2018</rights><rights>Surgical Endoscopy is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-3cf7379991e5859e77aeb95d487407f5c5b07b8de3c67de352804593a1d496c23</citedby><cites>FETCH-LOGICAL-c438t-3cf7379991e5859e77aeb95d487407f5c5b07b8de3c67de352804593a1d496c23</cites><orcidid>0000-0003-1169-8160</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-018-6118-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-018-6118-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29484553$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nagakawa, Yuichi</creatorcontrib><creatorcontrib>Hosokawa, Yuichi</creatorcontrib><creatorcontrib>Sahara, Yatsuka</creatorcontrib><creatorcontrib>Takishita, Chie</creatorcontrib><creatorcontrib>Hijikata, Yosuke</creatorcontrib><creatorcontrib>Osakabe, Hiroaki</creatorcontrib><creatorcontrib>Nakajima, Tetsushi</creatorcontrib><creatorcontrib>Shirota, Tomoki</creatorcontrib><creatorcontrib>Katsumata, Kenji</creatorcontrib><creatorcontrib>Nakamura, Masafumi</creatorcontrib><creatorcontrib>Tsuchida, Akihiko</creatorcontrib><title>Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Although the artery-first approach is widely used in open pancreaticoduodenectomy, it is difficult to laparoscopically expose the origin of the inferior pancreaticoduodenal artery (IPDA) from the left side of the superior mesenteric artery (SMA). By contrast, damaging the inferior pancreaticoduodenal veins (IPDVs) is possible when approaching the IPDA from the right side of the SMA. To facilitate the artery-first approach in laparoscopic pancreaticoduodenectomy (LPD), we focused on the proximal-dorsal jejunal vein (PDJV) that branched from the superior mesenteric vein (SMV) dorsal side and drained the IPDVs. This study aimed to clarify the usefulness of the right SMA approach using the PDJV preisolation method.
Methods
The PDJV was first isolated, and the IPDVs were divided along the PDJV on the right side of the SMA. Then, the IPDA was divided at the root without first separating the pancreatic head from the portal vein and the SMV. Overall, 21 patients underwent this approach, and the results were retrospectively compared with those of 21 patients who underwent the artery-first approach, which was performed on the left side of the SMA. Anatomical characteristics of the PDJV were evaluated using multidetector computed tomography for the two groups.
Results
Operative times and resection times were significantly lower for the PDJV preisolation group than for the conventional LPD group (489.3 vs. 541.7 min, respectively;
p
= 0.002). During anatomical evaluation, 41 patients (97.6%) had a PDJV that drained from the SMV dorsally and was in contact with the anterior aspect of the uncinate process. The PDJV was confirmed as the first jejunal vein in 31 patients (73.8%) and as the second jejunal vein in 10 patients (23.8%).
Conclusions
This approach facilitates dissection of the IPDA on the right side of the SMA, thereby reducing operative times.</description><subject>Abdominal Surgery</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Laparoscopy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>New Technology</subject><subject>Pancreatic cancer</subject><subject>Pancreaticoduodenectomy</subject><subject>Proctology</subject><subject>Surgery</subject><subject>Veins & arteries</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp1kc9u1DAQxi0EotvCA3BBkbhwCfjv2j5WVaFIlbjA2fLak25WSRzsGLF9H96TWdKChMRlxpJ_3zea-Qh5xeg7Rql-XyiVW9lSZtotw3L_hGyYFLzlnJmnZEOtoC3XVp6R81IOFHHL1HNyxq00UimxIT8v5zknH_b9dNcse2hKnSH3KTcjFJgWfIfGZ-zHpstp_M3k_m6_NKWP0NTyKESbH_3ohzamXPzQHOBQJ-zfoZ_wE_qSBr_0aULnZZ9iE2s-aQc_-5xKSDNOmv0UMiAWUqwpwgRhSePxBXnW-aHAy4d-Qb5-uP5yddPefv746erytg1SmKUVodNCW2sZKKMsaO1hZ1WURkuqOxXUjuqdiSDCVmNV3FCprPAsSrsNXFyQt6svLvOtQlnc2JcAw-AnSLU4TqkxxhrKEH3zD3pINePCK8WslsIixVYq4IolQ-fmjEfKR8eoO2Xo1gwdZuhOGbp71Lx-cK67EeIfxWNoCPAVKPPpgpD_jv6_6y87KKv4</recordid><startdate>20180901</startdate><enddate>20180901</enddate><creator>Nagakawa, Yuichi</creator><creator>Hosokawa, Yuichi</creator><creator>Sahara, Yatsuka</creator><creator>Takishita, Chie</creator><creator>Hijikata, Yosuke</creator><creator>Osakabe, Hiroaki</creator><creator>Nakajima, Tetsushi</creator><creator>Shirota, Tomoki</creator><creator>Katsumata, Kenji</creator><creator>Nakamura, Masafumi</creator><creator>Tsuchida, Akihiko</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1169-8160</orcidid></search><sort><creationdate>20180901</creationdate><title>Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy</title><author>Nagakawa, Yuichi ; Hosokawa, Yuichi ; Sahara, Yatsuka ; Takishita, Chie ; Hijikata, Yosuke ; Osakabe, Hiroaki ; Nakajima, Tetsushi ; Shirota, Tomoki ; Katsumata, Kenji ; Nakamura, Masafumi ; Tsuchida, Akihiko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-3cf7379991e5859e77aeb95d487407f5c5b07b8de3c67de352804593a1d496c23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abdominal Surgery</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Laparoscopy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>New Technology</topic><topic>Pancreatic cancer</topic><topic>Pancreaticoduodenectomy</topic><topic>Proctology</topic><topic>Surgery</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nagakawa, Yuichi</creatorcontrib><creatorcontrib>Hosokawa, Yuichi</creatorcontrib><creatorcontrib>Sahara, Yatsuka</creatorcontrib><creatorcontrib>Takishita, Chie</creatorcontrib><creatorcontrib>Hijikata, Yosuke</creatorcontrib><creatorcontrib>Osakabe, Hiroaki</creatorcontrib><creatorcontrib>Nakajima, Tetsushi</creatorcontrib><creatorcontrib>Shirota, Tomoki</creatorcontrib><creatorcontrib>Katsumata, Kenji</creatorcontrib><creatorcontrib>Nakamura, Masafumi</creatorcontrib><creatorcontrib>Tsuchida, Akihiko</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Proquest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nagakawa, Yuichi</au><au>Hosokawa, Yuichi</au><au>Sahara, Yatsuka</au><au>Takishita, Chie</au><au>Hijikata, Yosuke</au><au>Osakabe, Hiroaki</au><au>Nakajima, Tetsushi</au><au>Shirota, Tomoki</au><au>Katsumata, Kenji</au><au>Nakamura, Masafumi</au><au>Tsuchida, Akihiko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2018-09-01</date><risdate>2018</risdate><volume>32</volume><issue>9</issue><spage>4044</spage><epage>4051</epage><pages>4044-4051</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Although the artery-first approach is widely used in open pancreaticoduodenectomy, it is difficult to laparoscopically expose the origin of the inferior pancreaticoduodenal artery (IPDA) from the left side of the superior mesenteric artery (SMA). By contrast, damaging the inferior pancreaticoduodenal veins (IPDVs) is possible when approaching the IPDA from the right side of the SMA. To facilitate the artery-first approach in laparoscopic pancreaticoduodenectomy (LPD), we focused on the proximal-dorsal jejunal vein (PDJV) that branched from the superior mesenteric vein (SMV) dorsal side and drained the IPDVs. This study aimed to clarify the usefulness of the right SMA approach using the PDJV preisolation method.
Methods
The PDJV was first isolated, and the IPDVs were divided along the PDJV on the right side of the SMA. Then, the IPDA was divided at the root without first separating the pancreatic head from the portal vein and the SMV. Overall, 21 patients underwent this approach, and the results were retrospectively compared with those of 21 patients who underwent the artery-first approach, which was performed on the left side of the SMA. Anatomical characteristics of the PDJV were evaluated using multidetector computed tomography for the two groups.
Results
Operative times and resection times were significantly lower for the PDJV preisolation group than for the conventional LPD group (489.3 vs. 541.7 min, respectively;
p
= 0.002). During anatomical evaluation, 41 patients (97.6%) had a PDJV that drained from the SMV dorsally and was in contact with the anterior aspect of the uncinate process. The PDJV was confirmed as the first jejunal vein in 31 patients (73.8%) and as the second jejunal vein in 10 patients (23.8%).
Conclusions
This approach facilitates dissection of the IPDA on the right side of the SMA, thereby reducing operative times.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>29484553</pmid><doi>10.1007/s00464-018-6118-z</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-1169-8160</orcidid></addata></record> |
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| ispartof | Surgical endoscopy, 2018-09, Vol.32 (9), p.4044-4051 |
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| language | eng |
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| source | Springer Nature - Complete Springer Journals |
| subjects | Abdominal Surgery Gastroenterology Gynecology Hepatology Laparoscopy Medicine Medicine & Public Health New Technology Pancreatic cancer Pancreaticoduodenectomy Proctology Surgery Veins & arteries |
| title | Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy |
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