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Artery-First Distal Pancreatectomy.

Kyoichi Takaori1, Shinji Uemoto

  • 1Division of Hepatobiliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Digestive Surgery
|May 25, 2016
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Summary

Artery-first distal pancreatectomy (DP) offers improved oncologic resection and reduced blood loss. A novel "Tora-no-Ana" approach and hanging maneuver facilitate safe and feasible artery-first DP, enhancing visualization of the splenic artery.

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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery

Background:

  • Artery-first pancreatectomy aims to reduce blood loss and improve oncologic resection by ligating the feeding artery before pancreatic division.
  • Artery-first distal pancreatectomy (DP) can aid in determining resectability for pancreatic cancer involving the splenic artery (SA) or celiac artery.
  • Exposure difficulties, particularly of the SA origin in open surgery, have limited the performance of artery-first DP.

Purpose of the Study:

  • To present a refined technique for artery-first DP using the 'Tora-no-Ana' approach.
  • To demonstrate the feasibility and safety of artery-first DP with improved visualization of the SA origin.

Main Methods:

  • Developed the 'Tora-no-Ana' approach involving posterior dissection of the pancreatic body via division of the ligament of Treitz.
  • Utilized a hanging maneuver of the pancreatic parenchyma with the SA and vein for enhanced visualization.
  • Applied this technique in open, laparoscopic, and robotic DP settings.

Main Results:

  • The 'Tora-no-Ana' approach and hanging maneuver allow clear visualization and identification of the SA origin.
  • This technique facilitates oncologic resection in artery-first DP.
  • Artery-first DP was demonstrated to be safe and feasible when adhering to the described surgical principles.

Conclusions:

  • Artery-first DP is a safe and feasible surgical option.
  • The 'Tora-no-Ana' approach and hanging maneuver are crucial for successful artery-first DP.
  • This technique improves visualization and enables oncologic resection in DP.