Precision vascular anatomy for minimally invasive distal pancreatectomy: A systematic review

Abstract

Background Minimally invasive distal pancreatectomy (MIDP) is increasingly performed worldwide; however, the surgical anatomy required to safely perform MIDP has not yet been fully considered. This review evaluated the literature concerning peripancreatic vascular anatomy, which is considered important to conduct safe MIDP. Methods A database search of PubMed and Ichushi (Japanese) was conducted. Qualified studies investigating the anatomical variations of peripancreatic vessels related to MIDP were evaluated using SIGN methodology. Results Of 701 articles yielded by our search strategy, 76 articles were assessed in this systematic review. The important vascular anatomy required to recognize MIDP included the pancreatic parenchymal coverage on the root and the running course of the splenic artery, branching patterns of the splenic artery, confluence positions of the left gastric vein and the inferior mesenteric vein, forms of pancreatic veins including the centro‐inferior pancreatic vein, characteristics of the left renal vein, and collateral routes perfusing the spleen following Warshaw's technique. Very few articles evaluating the relationship between the anatomical variations and surgical outcomes of MIDP were found. Conclusions The precise knowledge of peripancreatic vessels is important to adequately complete MIDP. More detailed anatomic analyses and descriptions will benefit surgeons and their patients who are facing these operations.

International Expert Consensus on Precision Anatomy for minimally invasive distal pancreatectomy: PAM‐HBP Surgery Project

“…However, no other large‐scale studies have compared these two approaches 19 . Variations in the anatomical location of the SpA root may affect the difficulty and the surgical outcomes of the approach to the SpA during MIDP 18‐20 . The survey revealed that 36% of experts considered the anterior approach to be the first choice, while 8% considered the posterior approach to be the first choice.…”

“…As the first step in this project, we reviewed the available evidence in the literature. As expected, very few studies provided scientific evidence that could ensure the recommendations 18,19 . Most of the articles reviewed were case series and case reports that were categorized as “expert opinions,” and few RCTs and comparative studies with large numbers of patients were identified.…”

“…Although more of the experts surveyed preferred MI‐KT over MI‐WT (64% vs 4%, respectively), we finalized our recommendation on this topic to reflect the importance of knowing both approaches, as opinions regarding the preferred approach have varied. Preservation of the left gastric vein, left gastroepiploic vein, and splenic hilum veins was recommended to prevent symptomatic gastric varices due to SpV resection during MI‐WT or SpV occlusion after MI‐KT 18,19 . However, some experts commented that it remains uncertain whether preservation of the left gastroepiploic vein is mandatory as a collateral pathway of the SpV during MI‐SPDP.…”

“…19 Variations in the anatomical location of the SpA root may affect the difficulty and the surgical outcomes of the approach to the SpA during MIDP. [18][19][20] The survey revealed that 36% of experts considered the anterior approach to be the first choice, while 8% considered the posterior approach to be the first choice. However, 44% of experts responded that the approach to the SpA should be selected on a case-bycase basis.…”

Ligation of Left Gastric Vein May Cause Delayed Gastric Emptying After Pancreatoduodenectomy: A Retrospective Study

“…Using computed tomography performed before surgery and intraoperative ndings from operation records, we investigated the anatomy of the LGV and classi ed it into four types according to the running pattern of the LGV, ventral or distal route of the common hepatic artery (CHA) and splenic artery (SpA) arcade, and joining point to the veins of the portal vein (PV) or splenic vein (SpV). Previous reports have identi ed three positions for LGV con uence into major veins: the PV, SpV, and junction of the PV and SpV [15,16]. However, Kawasaki et al described a relationship between the LGV and arteries around the pancreas [17].…”