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Precision vascular anatomy for minimally invasive distal pancreatectomy: A systematic review
Hitoe Nishino1, Giuseppe Zimmitti2, Takao Ohtsuka3
1Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan.
Background:
Minimally invasive distal pancreatectomy (MIDP) is increasingly performed worldwide; however, the surgical anatomy required to safely perform MIDP has not yet been fully considered. This review evaluated the literature concerning peripancreatic vascular anatomy, which is considered important to conduct safe MIDP.
Methods:
A database search of PubMed and Ichushi (Japanese) was conducted. Qualified studies investigating the anatomical variations of peripancreatic vessels related to MIDP were evaluated using SIGN methodology.
Results:
Of 701 articles yielded by our search strategy, 76 articles were assessed in this systematic review. The important vascular anatomy required to recognize MIDP included the pancreatic parenchymal coverage on the root and the running course of the splenic artery, branching patterns of the splenic artery, confluence positions of the left gastric vein and the inferior mesenteric vein, forms of pancreatic veins including the centro-inferior pancreatic vein, characteristics of the left renal vein, and collateral routes perfusing the spleen following Warshaw's technique. Very few articles evaluating the relationship between the anatomical variations and surgical outcomes of MIDP were found.
Conclusions:
The precise knowledge of peripancreatic vessels is important to adequately complete MIDP. More detailed anatomic analyses and descriptions will benefit surgeons and their patients who are facing these operations.
Insights
Understanding peripancreatic vascular anatomy is crucial for safe minimally invasive distal pancreatectomy (MIDP). This review highlights key vascular details essential for surgeons performing MIDP procedures.
Area of Science:
- Surgical Anatomy
- Vascular Anatomy
- Minimally Invasive Surgery
Background:
- Minimally invasive distal pancreatectomy (MIDP) is a growing surgical procedure.
- A comprehensive understanding of peripancreatic vascular anatomy is vital for safe MIDP execution.
- Existing literature lacks detailed consideration of the specific surgical anatomy required for MIDP.
Purpose of the Study:
- To systematically review and evaluate the literature on peripancreatic vascular anatomy relevant to minimally invasive distal pancreatectomy (MIDP).
- To identify critical vascular structures and variations important for the safe performance of MIDP.
Main Methods:
- Systematic literature search of PubMed and Ichushi databases.
- Evaluation of qualified studies on peripancreatic vessel anatomical variations using SIGN methodology.
- Inclusion of 76 articles from an initial search of 701 for detailed assessment.
Main Results:
- Key vascular anatomy for MIDP includes splenic artery course and branching, pancreatic vein confluence, left renal vein characteristics, and splenic collateral routes.
- Specific anatomical considerations identified: pancreatic parenchymal coverage, splenic artery patterns, left gastric and inferior mesenteric vein confluence, pancreatic vein forms (e.g., centro-inferior), left renal vein, and splenic collateral routes (Warshaw's technique).
- Limited studies correlated anatomical variations with MIDP surgical outcomes.
Conclusions:
- Precise knowledge of peripancreatic vascular anatomy is essential for successful minimally invasive distal pancreatectomy (MIDP).
- Enhanced anatomical analyses and descriptions are needed to improve surgical safety and patient outcomes in MIDP.
- Further research correlating anatomical variations with surgical outcomes is recommended.
