• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Preservation of the ALHA (accessory left hepatic artery) in robot-assisted D2 gastric resections.

Graziano Pernazza, MD1, Pasquale Paolantonio, MD1, Francesca Abbatini, MD2, Riccardo Ferrari, MD1, Paolo Mazzocchi, MD1, Stefano Mattacchione, MD2, Carlo E Vitelli, MD1. 1AO San Giovanni Addolorata, Rome, IT, 2“Sapienza” University of Rome, Rome, IT

BACKGROUND

Technical challenges in gastric MIS has led to a more detailed studying of local anatomy in the preoperative workup.

Systematic preoperative multiphase 3D-CT scan allows to describe arterial and venous anatomy and to identify their variants, thus enabling to avoid accidental hemorrhage or ischemic liver damage and to accomplish a secure lymphadenectomy.

MATERIAL & METHODS

Since January 2010, 26 consecutive full robot-assisted total and subtotal gastrectomies with extended D2-lymphadenectomy for histologically proven gastric adenocarcinoma were performed by a single surgeon.

CT-angiography (CTA) of splacnic vessels was performed using 64-MDCT scanner using a multiphase contrast-enhanced dynamic study.

In 8 cases the presence of an accessory left hepatic accessory artery (ALHA) coming from the left gastric artery (LGA) was detected. In 4 of them the ALHA was the unique tributary branch of the left liver.

RESULTS

Preservation of the ALHA was succesfully achieved in all the cases, completing the lymphadenectomy along the main trunk of the LGA, performing the division of the artery just above the origin of the ALHA.

Vascular lesions or bleeding during vascular skeletonization never occurred. Median number of harvested lymph nodes was 37,6 (23–44). Resection was radical (R0) in all the cases. Mean operative time was 305 min. No conversion occurred. Postoperative laboratory data indicating hepatic function were not altered.

DISCUSSION

Widespread diffusion of minimally-invasive surgery for gastric cancer treatment is limited by the complexity of performing an extended D2-lymphadenectomy. This surgical step remains one of the most challenging tasks in conventional laparoscopic surgery, due to potential bleeding. Either in open and in minimally invasive surgery, systematic proximal division of the left gastric artery during D2 lymphadenectomy for gastric cancer is the usual procedure. In presence of an “accessory” or “replaced” left hepatic artery, this might induce transient postoperative liver dysfunction, but lethal complications, such as liver necrosis or death caused by division of the artery, have also been reported.

Lymphadenectomy can be more easily performed by using robot-assisted surgery, especially when an extended vascular preparation is requested.

In our experience of a consecutive series of 26 full robotic gastrectomies with D2-lymphadenectomy for gastric cancer, ALHA emerging from the LGA was not uncommon (30,8%) even if the presence of a unique aberrant left hepatic artery emerging from the celiac trunk or the left gastric artery was a quite rare condition (15,4%).

CONCLUSION

Robot-assisted gastrectomy with D2-lymphadenectomy is a safe technique allowing an adequate lymph node harvest and optimal R0-resection rates with low postoperative morbidity offering an extra-value in fine dissections around the vascular structures.

High resolution MDCT study may give useful information to plan the surgical procedure, preoperatively revealing eventual anatomical variations.

In our series, robotic assistance allowed to perform everytime a radical resection, achieveing an adequate number of lymphnodes, and preserving the accessory or unique “replaced” arterial vascularization to the left liver.

103

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2015 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons