Complications in right‐sided paraaortic lymphadenectomy: ventral tributaries of the inferior vena cava

Abstract

The purpose of this study was to describe the distribution and structure of ventral tributaries leading into the inferior vena cava where right-sided paraaortic lymphadenectomy is performed. The study examined 21 retroperitoneal specimens by graphic reconstruction, statistical evaluation, and histological examination of ventral tributaries (VTs). Seventy VTs were identified. The average number per specimen was 3.33. There were 20, 40, and 40% of VTs found in Levels I, II, and III, respectively. During the preparation, we observed an unusual arrangement of the IVC wall, into which VTs were led through a preformed sleeve-like channel and anchored near the lumen. This finding is a key mechanism that explains the ease with which VTs are extracted during surgery. Knowledge of the distribution and histological structure of VTs allows proper orientation of the retroperitoneal area of the front wall of inferior vena cava, which is essential for uncomplicated right-sided paraaortic lymphadenectomy. The histological structure of the VT ostium within the wall of the inferior vena cava explains why injury is easy during the procedure.

A “Dangerous Vessel” — Description of a potentially hazardous vein during para-aortic lymphadenectomy

“…10 After consulting several anatomy atlases, we conclude that to our best knowledge this vessel has not been separately described yet. While the Turyna et al were able to describe multiple veins feeding into the IVC and their different frequency of occurrence in cadaver specimens, 3 we did trace our vein back to its origin on living patients. However, the numbers of the prospective assessed patients are low and thereby represent a limiting factor of our analysis.…”

“…Usually, anatomical understanding of the IVC is restricted to its segments, major tributaries, and most common anomalies. Possover 2 and Turyna 3 divided these tributaries into four levels. Tributaries at the area of bifurcation of IVC are considered as level 1.…”

“…Each individual possesses 2 to 3 ventral tributaries. 2,3 Lymph node status is an important prognostic indicator of the treatment outcomes among common gynecological cancers (cervical and endometrial cancers). 4 Para-aortic lymphadenectomy (PLA) is a standard procedure in gynecologic oncology and is used for the treatment of ovarian, endometrial, and cervical cancers.…”

Terminologia Anatomica after 17 years: Inconsistencies, mistakes and new proposals

“…Its wall is very thin and can be perforated during catheterization; • cavitas vaginalis testis (obsolete terms "cavum serosum scroti" or "cavum vaginale") is a narrow slit between two layers (lamina parietalis et visceralis) of tunica vaginalis testis, a remnant of processus vaginalis peritonei, an evagination of peritoneal cavity located dorsally to the descending scrotum, which later becomes obliterated and loses all previous connections with the peritoneal cavity; • crus sinistrum fasciculi atrioventricularis (left crus of Tawara) bifurcates into crus anterosinistrum and crus posterosinistrum, which may suffer from blockades; • rami retroperitoneales anteriores are minute direct branches from the aorta abdominalis, arteria testicularis/ovarica, arteria iliaca communis, arteria renalis and arteria renalis accessoria, supplying the adjacent lymph nodes, ureter, peritoneum, loose connective tissue around the aorta abdominalis and vena cava inferior, autonomic nervous plexuses, ganglia and finally, the wall of both large vessels in a form of vasa vasorum. These arteries are accompanied by corresponding veins, draining into the anterior aspect of vena cava inferior and its tributaries, termed the venae retroperitoneales anteriores (Turyna et al, 2013 andTuryna et al, 2014).…”

A plea for an extension of the anatomical nomenclature: Organ systems

“…• Small branches supplying the fine structures of the retroperitoneum (such as ureter, nodi lymphoidei lumbales, adipose tissue, sympathetic plexuses, and ganglia) related to large vessels of the abdomen, emanating from arteria renalis, arteria renalis accessoria, arteria testicularis/ovarica, arteria iliaca communis, or directly from aorta abdominalis can be termed rami retroperitoneales anteriores as they emerge from the anterior aspect of aorta abdominalis. Their accompanying veins entering the anterior aspect of vena cava inferior (or its tributaries) can be similarly called venae retroperitoneales anteriores [9,37,38].…”