Kohei Nakata1, Ryota Higuchi2, Naoki Ikenaga1, Leon Sakuma3, Daisuke Ban4, Yuichi Nagakawa5, Takao Ohtsuka6, Horacio J Asbun7, Ugo Boggi8, Chung-Ngai Tang9, Christopher L Wolfgang10, Hitoe Nishino5, Itaru Endo11, Akihiko Tsuchida5, Masafumi Nakamura1. 1. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 2. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 3. Professor with Special Assistant, Kawasaki Medical School, Okayama, Japan. 4. Department of Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan. 5. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan. 6. First Department of Surgery, Kagoshima University School of Medicine, Kagoshima, Japan. 7. Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA. 8. Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy. 9. Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China. 10. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 11. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Abstract
BACKGROUND: Minimally invasive pancreatoduodenectomy (MIPD) has recently gained popularity. Several international meetings focusing on the existing literature on MIPD were held; however, the precise surgical anatomy of the pancreas for the safe use of MIPD has not yet been fully discussed. The aim of this study was to carry out a systematic review of available articles and to show the importance of identifying the anatomical variation in pancreatoduodenectomy. METHODS: In this review, we described variations in surgical anatomy related to MIPD. A systematic search of PubMed (MEDLINE) was conducted, and the references were identified manually. RESULTS: The search strategy yielded 272 articles, with 77 retained for analysis. The important anatomy to be considered during MIPD includes the aberrant right hepatic artery, first jejunal vein, first jejunal artery, and dorsal pancreatic artery. Celiac artery stenosis and a circumportal pancreas are also important to recognize. CONCLUSIONS: We conclude that only certain anatomical variations are associated directly with perioperative outcomes and that identification of these particular variations is important for safe performance of MIPD.
BACKGROUND: Minimally invasive pancreatoduodenectomy (MIPD) has recently gained popularity. Several international meetings focusing on the existing literature on MIPD were held; however, the precise surgical anatomy of the pancreas for the safe use of MIPD has not yet been fully discussed. The aim of this study was to carry out a systematic review of available articles and to show the importance of identifying the anatomical variation in pancreatoduodenectomy. METHODS: In this review, we described variations in surgical anatomy related to MIPD. A systematic search of PubMed (MEDLINE) was conducted, and the references were identified manually. RESULTS: The search strategy yielded 272 articles, with 77 retained for analysis. The important anatomy to be considered during MIPD includes the aberrant right hepatic artery, first jejunal vein, first jejunal artery, and dorsal pancreatic artery. Celiac artery stenosis and a circumportal pancreas are also important to recognize. CONCLUSIONS: We conclude that only certain anatomical variations are associated directly with perioperative outcomes and that identification of these particular variations is important for safe performance of MIPD.