6. Application of left superior mesenteric artery first approach in laparoscopic pancreaticoduodenectomy
Main Article Content
Abstract
This study is to describe the anatomical classification of the vessels of the head of pancreas based on Computed tomography (CT) and apply the superior mesenteric artery (SMA) first-approach technique in laparoscopic pancreaticoduodenectomy. This is a prospective study of non-controlled intervention on 20 patients diagnosed with resectable periampullary adenocarcinoma from 1/2021 to 12/2022. The results showed that 80% had inferior pancreaticoduodenal artery (IPAD) originating on the left side of the vena cava, 45% of the IPDA came from the first jejunal artery (FJA); 80% had ligation from the left side, 100% ligation of FJA at its origin; 100% of patients underwent total meso-pancreas dissection, 100% of the left-sided SMA lymph nodes were dissected from the left side of the SMA, the average number of harvested lymph nodes was 32.7 ± 8.8, with 55% of cases had lymph node metastasis; the number of lymph nodes dissected on the left side of the SMA was 8.3 ± 7.3 with 25% cases of lymph node metastasis, 30% have cancer cells infiltrating the meso-pancreas. Conclusions: Left SMA first-approach showed favorable results in the control of the IPDA, the FJA, as well as complete removal of the meso-pancreas, and extended dissection of the left-sided SMA lymph nodes. However, further studies are needed with a larger number of patients to evaluate the results of operative and survival outcomes.
Article Details
Keywords
Superior mesenteric artery first approach, total meso-pancreas dissection, laparoscopic pancreaticoduodenectomy
References
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