Three-dimensional reconstruction of vascular arrangement including the hepatic artery and left gastric vein during gastric surgery.

Ryoichi Miyamoto,Kentaro Nagai,Akira Kemmochi,Masayoshi Yamamoto,Satoshi Inagawa,Michihiro Maeda

doi:10.1186/s40064-016-2583-9

Abstract

BackgroundDuring gastric surgery, precise recognition of the anatomical variations and relationships among gastric tumors and vessels, including the hepatic artery (HA) and left gastric vein (LGV), is required. We utilized a three-dimensional (3D) reconstructed image as a preoperative simulation for gastric surgery.MethodsWe retrospectively analyzed 84 patients who underwent gastrectomy at Tsukuba Medical Center Hospital. This cohort was sequentially divided into a without-3D group (n = 42) and with-3D group (n = 42), and the perioperative outcomes were compared. The 3D image could be used to classify the HA or LGV arrangement pattern.ResultsRegarding the HA arrangement, the right HA of 1 patient (2.3 %) was arising from the superior mesenteric artery, the left HA of 8 patients (19 %) was arising from the left gastric artery, 29 patients (69 %) presented a normal rearrangement, and 4 patients (9.5 %) exhibited other arrangements. The analysis of the LGV arrangement revealed that the LGV in 15 patients (36 %) was located on the dorsal side of the common HA, the LGV in 5 patients (12 %) was located on the ventral side of the common HA, the LGV in 12 patients (29 %) was found on the ventral side of the splenic artery, the LGV in 6 patients (14 %) was located on the dorsal side of the splenic artery, and 4 patients (9.5 %) presented other arrangements. The intraoperative blood loss in the without-3D and with-3D groups was 276 ± 430 and 157 ± 170 g, respectively (p = 0.027).ConclusionsThe 3D reconstruction technique was useful for understanding and sharing anatomic information during gastric surgery.

Highlights

During gastric surgery, precise recognition of the anatomical variations and relationships among gastric tumors and vessels, including the hepatic artery (HA) and left gastric vein (LGV), is required
During gastric surgery, local lymph node excision commonly involves excision of the perigastric lymph nodes, such as the lymph nodes around the left gastric artery trunk, the lymph nodes in the anterosuperior region of the common hepatic artery, and the lymph nodes around the celiac artery
The patient characteristics, i.e., age, sex, body mass index (BMI), American Society of Anesthesiology (ASA) score, performance status, histopathological stage, surgical procedure, type of surgeon, perioperative outcomes, and postoperative complications were compared between the two groups

Summary

Introduction

Precise recognition of the anatomical variations and relationships among gastric tumors and vessels, including the hepatic artery (HA) and left gastric vein (LGV), is required. The areas near the left gastric vein (LGV) and hepatic artery (HA), which are known to contain various anatomical variations, are challenging sites for radical lymph node dissection. Preoperative assessment of the precise arrangement of the perigastric vascular supply, including the LGV and HA, might avoid unnecessary bleeding and facilitate a safe, rapid gastric surgery (Huang et al 2014; Rebibo et al 2012). As for the vascular components, including the HA and LGV, Jonathan et al and Koops et al previously reported that an unusual HA arrangement is present in 21–25 % of patients undergoing hepatic surgery (according to angiography) (Koops et al 2004; Hiatt et al 1994). Sakaguchi et al (2010) reported a confluent pattern of the LGV to the portal vein or splenic vein

Methods

Results

Conclusion