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Evaluation of relationship between splenic artery and pancreatic parenchyma using three-dimensional computed tomography for laparoscopic distal pancreatectomy

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Abstract

Aim

Isolating the root of the splenic artery (SPA) is a challenging procedure in laparoscopic distal pancreatectomy (LDP). We investigated the usefulness of evaluation of the relationship between the SPA and pancreatic parenchyma using three-dimensional computed tomography (3D-CT).

Methods

In total, 104 patients were evaluated. The relationship between the SPA and pancreatic parenchyma was classified into two types: buried and non-buried. Video clips of 50 patients who underwent LDP requiring isolation of the SPA root were reviewed to determine whether the classification is related to difficulty of LDP.

Results

Of the 50 assessed patients who underwent LDP, the relationship between the SPA and pancreatic parenchyma was the buried type in 30 (60.0%) and non-buried type in 20 (40.0%). The buried type was associated with a significantly longer median operative time than the non-buried type (285.0 vs. 235.5 min, respectively; P < 0.01). The median time required to isolate the SPA in the buried type (25.8 min; range, 4.0–101 min) was significantly longer than that in the non-buried type (7.0 min; range, 1.0–27.0 min) (P < 0.001).

Conclusion

Preoperative 3D-CT around the pancreas is practical for predicting the difficulty of SPA isolation and determining the safety of the procedure.

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References

  1. Cuschieri A, Jakimowicz JJ, van Spreeuwel J (1996) Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis. Ann Surg. 223(3):280–285

    Article  CAS  Google Scholar 

  2. Inomata M, Shiroshita H, Uchida H, Bandoh T, Akira S, Yamaguchi S, Kurokawa Y, Seki Y, Eguchi S, Wada N, Takiguchi S, Ieiri S, Endo S, Iwazaki M, Sato Y, Tamaki Y, Kitamura K, Tabata M, Kanayama H, Mimata H, Hasegawa T, Takahashi H, Onishi K, Uemura T, Hashizume M, Matsumoto S, Kitano S, Watanabe M (2020) Current status of endoscopic surgery in Japan: the 14th National Survey of Endoscopic Surgery by the Japan Society for Endoscopic Surgery. Asian J Endosc Surg. 13(1):7–18

    Article  Google Scholar 

  3. Venkat R, Edil BH, Schulick RD, Lidor AO, Makary MA, Wolfgang CL (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg. 255(6):1048–1059

    Article  Google Scholar 

  4. Nakamura M, Nakashima H (2013) Laparoscopic distal pancreatectomy and pancreatoduodenectomy: is it worthwhile? A meta-analysis of laparoscopic pancreatectomy. J Hepatobiliary Pancreat Sci. 20(4):421–428

    Article  Google Scholar 

  5. Riviere D, Gurusamy KS, Kooby DA, Vollmer CM, Besselink MG, Davidson BR et al (2016) Laparoscopic versus open distal pancreatectomy for pancreatic cancer. Cochrane Database Syst Rev. 4:CD011391

    PubMed  Google Scholar 

  6. Nakamura M, Wakabayashi G, Miyasaka Y, Tanaka M, Morikawa T, Unno M, Tajima H, Kumamoto Y, Satoi S, Kwon M, Toyama H, Ku Y, Yoshitomi H, Nara S, Shimada K, Yokoyama T, Miyagawa S, Toyama Y, Yanaga K, Fujii T, Kodera Y, Study Group of JHBPS, JSEPS, Tomiyama Y, Miyata H, Takahara T, Beppu T, Yamaue H, Miyazaki M, Takada T (2015) Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching. J Hepatobiliary Pancreat Sci. 22(10):731–736

    Article  Google Scholar 

  7. Ohtsuka T, Ban D, Nakamura Y, Nagakawa Y, Tanabe M, Gotoh Y, Velasquez VVDM, Nakata K, Sahara Y, Takaori K, Honda G, Misawa T, Kawai M, Yamaue H, Morikawa T, Kuroki T, Mou Y, Lee WJ, Shrikhande SV, Tang CN, Conrad C, Han HS, Palanivelu C, Asbun HJ, Kooby DA, Wakabayashi G, Takada T, Yamamoto M, Nakamura M (2018) Difficulty scoring system in laparoscopic distal pancreatectomy. J Hepatobiliary Pancreat Sci. 25(11):489–497

    Article  Google Scholar 

  8. Hallet J, Gayet B, Tsung A, Wakabayashi G, Pessaux P (2015) nd International Consensus Conference on Laparoscopic Liver Resection G. Systematic review of the use of pre-operative simulation and navigation for hepatectomy: current status and future perspectives. J Hepatobiliary Pancreat Sci. 22(5):353–362

    Article  Google Scholar 

  9. Kinoshita T, Shibasaki H, Enomoto N, Sahara Y, Sunagawa H, Nishida T (2016) Laparoscopic splenic hilar lymph node dissection for proximal gastric cancer using integrated three-dimensional anatomic simulation software. Surg Endosc. 30(6):2613–2619

    Article  Google Scholar 

  10. Ohshima S (2014) Volume analyzer SYNAPSE VINCENT for liver analysis. J Hepatobiliary Pancreat Sci. 21(4):235–238

    Article  Google Scholar 

  11. Shioyama Y, Kimura M, Horihata K, Masuda M, Hagihira T, Okumura T, Yoshimi F, Amemiya R, Kishi K, Terada M, Sato M (2001) Peripancreatic arteries in thin-section multislice helical CT. Abdom Imaging. 26(3):234–242

    Article  CAS  Google Scholar 

  12. Bertelli E, Di Gregorio F, Mosca S, Bastianini A (1998) The arterial blood supply of the pancreas: a review. V. The dorsal pancreatic artery. An anatomic review and a radiologic study. Surg Radiol Anat. 20(6):445–452

    Article  CAS  Google Scholar 

  13. Macchi V, Picardi EEE, Porzionato A, Morra A, Bardini R, Loukas M, Tubbs RS, de Caro R (2017) Anatomo-radiological patterns of pancreatic vascularization, with surgical implications: clinical and anatomical study. Clin Anat. 30(5):614–624

    Article  Google Scholar 

  14. Natsume T, Shuto K, Yanagawa N, Akai T, Kawahira H, Hayashi H, Matsubara H (2011) The classification of anatomic variations in the perigastric vessels by dual-phase CT to reduce intraoperative bleeding during laparoscopic gastrectomy. Surg Endosc. 25(5):1420–1424

    Article  Google Scholar 

  15. Ishikawa Y, Ban D, Watanabe S, Akahoshi K, Ono H, Mitsunori Y, Kudo A, Tanaka S, Tanabe M (2019) Splenic artery as a simple landmark indicating difficulty during laparoscopic distal pancreatectomy. Asian J Endosc Surg. 12(1):81–87

    Article  Google Scholar 

  16. Lee LS, Hwang HK, Kang CM, Lee WJ (2016) Minimally invasive approach for spleen-preserving distal pancreatectomy: a comparative analysis of postoperative complication between splenic vessel conserving and Warshaw’s technique. J Gastrointest Surg. 20(8):1464–1470

    Article  Google Scholar 

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Acknowledgments

We thank Angela Morben, DVM, ELS, and Hugh McGonigle, from Edanz Group (https://en-author-services.edanz.com/ac), for editing drafts of this manuscript.

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Authors and Affiliations

  1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Kohei Nakata, Takao Ohtsuka, Yoshihiro Miyasaka, Yusuke Watanabe, Noboru Ideno, Yasuhisa Mori, Naoki Ikenaga & Masafumi Nakamura

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  1. Kohei Nakata
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  2. Takao Ohtsuka
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  3. Yoshihiro Miyasaka
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  4. Yusuke Watanabe
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  5. Noboru Ideno
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  6. Yasuhisa Mori
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  7. Naoki Ikenaga
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  8. Masafumi Nakamura
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Correspondence to Masafumi Nakamura.

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Conflict of interest

All authors (Drs. Kohei Nakata, Takao Ohtsuka, Yoshihiro Miyasaka, Yusuke Watanabe, Yasuhisa Mori, Naoki Ikenaga, and Masafumi Nakamura) have no conflicts of interest or financial ties to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study does not include animals. The Institutional Review Board of Kyushu University Hospital approved this study’s protocol (approved number 2019-089). The need for consent in this study is waived by our review board.

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Informed consent was obtained from all individual participants included in the study.

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Nakata, K., Ohtsuka, T., Miyasaka, Y. et al. Evaluation of relationship between splenic artery and pancreatic parenchyma using three-dimensional computed tomography for laparoscopic distal pancreatectomy. Langenbecks Arch Surg 406, 1885–1892 (2021). https://doi.org/10.1007/s00423-021-02101-3

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  • DOI: https://doi.org/10.1007/s00423-021-02101-3

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