Three-dimensional surgical simulation of the bile duct and vascular arrangement in pancreatoduodenectomy: A retrospective cohort study.

Ryoichi Miyamoto,Naoki Sano,Nobuhiro Ohkohchi,Yukio Oshiro,Satoshi Inagawa

doi:10.1016/j.amsu.2018.09.043

Ryoichi Miyamoto, Naoki Sano + Show 3 more

Open Access

https://doi.org/10.1016/j.amsu.2018.09.043

Copy DOI

Abstract

Background/aimsWe evaluated the usefulness of three-dimensional (3D) images for pancreatoduodenectomy (PD), including the classification of the bile duct and vascular arrangement, i.e., hepatic artery, inferior mesenteric vein (IMV) and left gastric vein (LGV). We evaluated the extent to which this simulation affected the perioperative outcomes of PD.MethodsIn all, 117 patients who underwent PD were divided into the without-3D (n = 53) and with-3D (n = 64) groups, and perioperative outcomes were compared. We evaluated the arrangement of the accessory bile duct and the hepatic artery (type I: the right hepatic artery arising from the superior mesenteric artery, type II: the left hepatic artery arising from the left gastric artery, type III: the most common pattern) and the confluence pattern of the LGV and the IMV [type i: portal vein (PV):splenic vein (SV), type ii: PV:superior mesenteric vein (SMV), type iii: SV:SV, and type iv: SV:SMV] between the two groups.ResultsTwo patients had an accessory bile duct. The 3D images were classified as type I (n = 4), type II (n = 10), type III (n = 48) and other patterns (n = 2); type ii (n = 27) was the most frequent confluence pattern (p < 0.05). Intraoperative blood loss was reduced in the with-3D group (p < 0.05).ConclusionsWe propose that the 3D imaging technique is useful for preoperative assessment in PD.

Highlights

Anatomical variations are frequently encountered in hepato-biliarypancreatic surgeries, which necessitate a precise understanding of the positional relationships among the lesions, surrounding organs, and vessel arrangements to perform a safe surgery [1,2]
Jonathan et al and Koops et al reported that unusual hepatic artery arrangements of the vascular components, i.e., the hepatic artery, portal vein (PV), left gastric vein (LGV) and inferior mesenteric vein (IMV), were present in 21–25% of patients undergoing hepatic surgery [8,9]
Recent advances in diagnostic imaging technology, such as multi-detector computed tomography (MDCT) and magnetic resonance cholangiopancreatography (MRCP), have enabled the collection of detailed information preoperatively, these methods have proven insufficient to determine the relative positions of the bile duct and vascular components, i.e., the hepatic artery, PV, LGV and IMV, and the parenchymal organs, such as the pancreas and liver

Summary

Introduction

Anatomical variations are frequently encountered in hepato-biliarypancreatic surgeries, which necessitate a precise understanding of the positional relationships among the lesions, surrounding organs, and vessel arrangements to perform a safe surgery [1,2]. Recent advances in diagnostic imaging technology, such as multi-detector computed tomography (MDCT) and magnetic resonance cholangiopancreatography (MRCP), have enabled the collection of detailed information preoperatively, these methods have proven insufficient to determine the relative positions of the bile duct and vascular components, i.e., the hepatic artery, PV, LGV and IMV, and the parenchymal organs, such as the pancreas and liver. We originally developed a method of merging MDCT and MRCP images and applied a 3D surgical simulation for pancreatic surgery [11,12,13,14,15] By integrating these two image types, we have been able to understand the anatomical relationships between nearby vascular structures and the pancreas. We have been able to simulate the pancreatic dissection line and resulting anatomical image before performing the reconstruction procedure

Methods

Results

Conclusion