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Surgical Endoscopy
Published in: Surgical Endoscopy 8/2018

01-08-2018 | Dynamic Manuscript

The anatomical configuration of the splenic artery influences suprapancreatic lymph node dissection in laparoscopic gastrectomy: analysis using a 3D volume rendering program

Authors: Chunchao Zhu, Seong-Ho Kong, Tae-Han Kim, Shin-Hoo Park, Rene Ronson G. Ang, Michele Diana, Luc Soler, Yun-Suhk Suh, Hyuk-Joon Lee, Jacques Marescaux, Hui Cao, Han-Kwang Yang

Published in: Surgical Endoscopy | Issue 8/2018

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Abstract

Background

The aim of this study is to categorize splenic artery and vein configurations, and examine their influence on suprapancreatic lymph node (LN) dissection in laparoscopic gastrectomy.

Methods

Digital Imaging and Communications in Medicine images from 169 advanced cancer patients who underwent laparoscopic gastrectomy with D2 dissection were used to reconstruct perigastric vessels in 3D using a volume rendering program (VP Planning®). Splenic artery and vein configuration were classified depending on the relative position of their lowest part in regard to the pancreas. Number of resected LNs and surgical outcomes were analyzed.

Results

The splenic artery was categorized as superficial (36.7%), middle (49.1%), and concealed (14.2%), and the splenic vein was categorized as superior (6.5%), middle (42.0%), and inferior to the pancreas (51.5%). The number of resected LNs around the proximal half of the splenic artery (#11p) and the proportion of the splenic vein located inferiorly to the pancreas were significantly higher in splenic arteries of concealed types. LN metastasis of station #7 was an independent risk factor of LN metastasis in station #11p (p = 0.010). Concealed types showed a tendency towards longer operating times, more blood loss, longer hospital stays, and a higher postoperative morbidity.

Conclusion

Concealed types of splenic artery are associated with an increased difficulty in the dissection of LN station #11p around the splenic artery. A 3D volume rendering program is a useful tool to rapidly and intuitively identify individual anatomical variations, to plan a tailored surgical strategy, and to predict potential challenges.
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Metadata
Title
The anatomical configuration of the splenic artery influences suprapancreatic lymph node dissection in laparoscopic gastrectomy: analysis using a 3D volume rendering program
Authors
Chunchao Zhu
Seong-Ho Kong
Tae-Han Kim
Shin-Hoo Park
Rene Ronson G. Ang
Michele Diana
Luc Soler
Yun-Suhk Suh
Hyuk-Joon Lee
Jacques Marescaux
Hui Cao
Han-Kwang Yang
Publication date
01-08-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 8/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6201-5

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