BACKGROUND: It is imperative for surgeons to have a proper knowledge of the omental bursa in order to perform an adequate dissection during minimally invasive surgery (MIS) of the upper gastrointestinal (GI) tract. This study aimed to describe (1) the various approaches which can be used to enter the bursa and to perform a complete lymphadenectomy, (2) the boundaries and anatomical landmarks of the omental bursa as seen during MIS, and (3) whether a bursectomy should be performed for oncological reasons in upper GI cancer. METHODS: In this observational study, videos of 20 patients undergoing different MIS procedures were reviewed, and the findings were verified prospectively in 5 patients undergoing a total gastrectomy and in a transversely sectioned cadaver. A systematic literature review (PubMed) was performed on the additive value of bursectomy during gastrectomy for cancer. RESULTS: The omental bursa can be surgically entered through the hepatogastric ligament, gastrocolic ligament, gastrosplenic ligament or through the transverse mesocolon. Anatomical boundaries of the omental bursa could be clearly identified, and new anatomical landmarks were described (gastro-omental folds). The cranial part of the omental bursa consists of two compartments (splenic recess and superior recess), separated by the gastropancreatic fold, communicating at the level of the pancreas, and extending distally as the inferior recess. There is no clear evidence regarding beneficial effect of a bursectomy in upper GI oncology. CONCLUSIONS: The description of the omental bursa in this study may help surgeons perform a more adequate oncological dissection during MIS. Bursectomy should not be routinely performed during oncological resections.
BACKGROUND: It is imperative for surgeons to have a proper knowledge of the omental bursa in order to perform an adequate dissection during minimally invasive surgery (MIS) of the upper gastrointestinal (GI) tract. This study aimed to describe (1) the various approaches which can be used to enter the bursa and to perform a complete lymphadenectomy, (2) the boundaries and anatomical landmarks of the omental bursa as seen during MIS, and (3) whether a bursectomy should be performed for oncological reasons in upper GI cancer. METHODS: In this observational study, videos of 20 patients undergoing different MIS procedures were reviewed, and the findings were verified prospectively in 5 patients undergoing a total gastrectomy and in a transversely sectioned cadaver. A systematic literature review (PubMed) was performed on the additive value of bursectomy during gastrectomy for cancer. RESULTS: The omental bursa can be surgically entered through the hepatogastric ligament, gastrocolic ligament, gastrosplenic ligament or through the transverse mesocolon. Anatomical boundaries of the omental bursa could be clearly identified, and new anatomical landmarks were described (gastro-omental folds). The cranial part of the omental bursa consists of two compartments (splenic recess and superior recess), separated by the gastropancreatic fold, communicating at the level of the pancreas, and extending distally as the inferior recess. There is no clear evidence regarding beneficial effect of a bursectomy in upper GI oncology. CONCLUSIONS: The description of the omental bursa in this study may help surgeons perform a more adequate oncological dissection during MIS. Bursectomy should not be routinely performed during oncological resections.
Entities:
Keywords:
Omental bursa; laparoscopy; minimally invasive surgery (MIS); upper GI
Authors: Joel Shapiro; J Jan B van Lanschot; Maarten C C M Hulshof; Pieter van Hagen; Mark I van Berge Henegouwen; Bas P L Wijnhoven; Hanneke W M van Laarhoven; Grard A P Nieuwenhuijzen; Geke A P Hospers; Johannes J Bonenkamp; Miguel A Cuesta; Reinoud J B Blaisse; Olivier R C Busch; Fiebo J W Ten Kate; Geert-Jan M Creemers; Cornelis J A Punt; John Th M Plukker; Henk M W Verheul; Ernst J Spillenaar Bilgen; Herman van Dekken; Maurice J C van der Sangen; Tom Rozema; Katharina Biermann; Jannet C Beukema; Anna H M Piet; Caroline M van Rij; Janny G Reinders; Hugo W Tilanus; Ewout W Steyerberg; Ate van der Gaast Journal: Lancet Oncol Date: 2015-08-05 Impact factor: 41.316
Authors: Leonie Haverkamp; Hylke J F Brenkman; Maarten F J Seesing; Suzanne S Gisbertz; Mark I van Berge Henegouwen; Misha D P Luyer; Grard A P Nieuwenhuijzen; Bas P L Wijnhoven; Jan J B van Lanschot; Wobbe O de Steur; Henk H Hartgrink; Jan H M B Stoot; Karel W E Hulsewé; Ernst J Spillenaar Bilgen; Jeroen E Rütter; Ewout A Kouwenhoven; Marc J van Det; Donald L van der Peet; Freek Daams; Werner A Draaisma; Ivo A M J Broeders; Henk F van Stel; Miangela M Lacle; Jelle P Ruurda; Richard van Hillegersberg Journal: BMC Cancer Date: 2015-07-29 Impact factor: 4.430
Authors: Andres Isaza-Restrepo; Juan S Martin-Saavedra; Juan L Velez-Leal; Felipe Vargas-Barato; Rafael Riveros-Dueñas Journal: Front Physiol Date: 2018-06-15 Impact factor: 4.566