Cattell‐Braasch maneuver in pancreatic surgery. No need of venous graft for vascular resection

Muttillo, Edoardo Maria; Felli, Emanuele; Pessaux, Patrick

doi:10.1002/jso.26180

Cited by 4 publications

(2 citation statements)

References 18 publications

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“…Especially in cases that require more than 5 cm of venous segment resection, the available reconstruction options (autologous, heterologous, or polytetrafluethylene graft) have significant specific drawbacks, making their use problematic [40,47,48]. Contrary to these methods, the Cattell-Braasch-Valdoni maneuver can be easily performed, allowing a safe and tension-free direct end-to-end venous anastomosis, regardless of the length of the resected venous segment [49] since the distal SMV stump can easily be shifted cranially because the root of the small bowel mesentery is completely mobilized [50].…”

Section: Discussionmentioning

confidence: 99%

“Mesopancreas-first” radical resection of pancreatic head cancer following the Cattell–Braasch–Valdoni maneuver: Appreciating the legacy of pioneers in visceral surgery

Vasiliadis

2021

Ann Hepatobiliary Pancreat Surg

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How-I-Do-ItThe "artery-first" approach pancreaticoduodenectomy, with maximal mesopancreas excision and central vascular ligation, represents the current principal determinants of radicality in pancreatic head cancer resection. However, these modifications at the resection stage of pancreaticoduodenectomy constitute extremely demanding and technically complicated procedures. Among the most critical contributing factors in the difficulty of artery-first approaches is the spiral configuration of the mesoduodenum and proximal mesojejunum around the superior mesenteric artery axis. This creates complicated tridimensional anatomy, making surgical dissection in the inferior peripancreatic anatomic area extremely challenging and demanding. The Cattell-Braasch-Valdoni maneuver (right-sided medial visceral mobilization and intestinal derotation maneuver) restores the embryological twist of the duodenojejunal junction, which demystifies the distorted peripancreatic vascular anatomy and facilitates a safe and radical "mesopancreas-first" pancreatic head cancer resection. The aim of this paper was to present the advantages, efficacy, and safety of the Cattell-Braasch-Valdoni maneuver in artery-first approach radical pancreaticoduodenectomy and provide a detailed description of its surgical technique.

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Section: Discussionmentioning

confidence: 99%

“Mesopancreas-first” radical resection of pancreatic head cancer following the Cattell–Braasch–Valdoni maneuver: Appreciating the legacy of pioneers in visceral surgery

Vasiliadis

2021

Ann Hepatobiliary Pancreat Surg

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“…In RATP, we noted fewer direct, end-to-end, vein reconstructions with a proportional increase in type 4 procedures. This can be readily explained by the need to place the patient in reverse Trendelenburg position [17] and the relative inability to perform a Cattell-Braasch maneuver [64]. Due to these challenges, other groups prefer to pursue type 1-2 vein resections/reconstructions during minimally invasive procedures [65][66][67][68].…”

Section: Technical Considerationsmentioning

confidence: 99%

Feasibility and safety of robotic-assisted total pancreatectomy: a pilot western series

et al. 2021

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This study was designed to demonstrate non-inferiority of robot-assisted total pancreatectomy (RATP) to open total pancreatectomy (OPT) based on an intention-to-treat analysis, having occurrence of severe post-operative complications (SPC) as primary study endpoint. The two groups were matched (2:1) by propensity scores. Assuming a rate of SPC of 22.5% (non-inferiority margin: 15%; α: 0.05; β: 0.20; power: 80%), a total of 25 patients were required per group. During the study period (October 2008–December 2019), 209 patients received a total pancreatectomy. After application of exclusion and inclusion criteria, matched groups were extracted from an overall cohort of 132 patients (OPT: 107; RATP: 25). Before matching, the two groups were different with respect to prevalence of cardiac disease (24.3% versus 4.0%; p = 0.03), presence of jaundice (45.8% versus 12.0%; p = 0.002), presence of a biliary drainage (23.4% versus 0; p = 0.004), history of weight loss (28.0% versus 8.0%; p = 0.04), and vein involvement (55.1% versus 28.0%) (p = 0.03). After matching, the two groups (OTP: 50; RATP: 25) were well balanced. Regarding primary study endpoint, SPC developed in 13 patients (26.0%) after OTP and in 6 patients (24.0%) after RATP (p = 0.85). Regarding secondary study endpoints, RATP was associated with longer median operating times [475 (408.8–582.5) versus 585 min (525–637.5) p = 0.003]. After a median follow-up time of 23.7 months (10.4–71), overall survival time [22.6 (11.2–81.2) versus NA (27.3–NA) p = 0.006] and cancer-specific survival [22.6 (11.2–NA) versus NA (27.3–NA) p = 0.02] were improved in patients undergoing RATP. In carefully selected patients, robot-assisted total pancreatectomy is non-inferior to open total pancreatectomy regarding occurrence of severe post-operative complications.

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Prepancreatic common hepatic artery arising from superior mesenteric artery: an exceptional but important finding during pancreaticoduodenectomy

et al. 2021

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Cattell‐Braasch maneuver in pancreatic surgery. No need of venous graft for vascular resection

Cited by 4 publications

References 18 publications

“Mesopancreas-first” radical resection of pancreatic head cancer following the Cattell–Braasch–Valdoni maneuver: Appreciating the legacy of pioneers in visceral surgery

“Mesopancreas-first” radical resection of pancreatic head cancer following the Cattell–Braasch–Valdoni maneuver: Appreciating the legacy of pioneers in visceral surgery

Feasibility and safety of robotic-assisted total pancreatectomy: a pilot western series

Prepancreatic common hepatic artery arising from superior mesenteric artery: an exceptional but important finding during pancreaticoduodenectomy

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