Vascular variants in laparoscopic extended right hemicolectomy with central vascular ligation for right colon cancer
Mitsuyoshi Tei1, Yozo Suzuki2, Masahisa Ohtsuka3
1Department of Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita-ku, Sakai, 591-8025, Japan. mtei@live.jp.
Insights
This study details the varied drainage patterns of accessory right and middle colic veins (aRCV/aMCV) encountered during laparoscopic extended right hemicolectomy. Understanding these variations is crucial for colorectal surgeons to prevent intraoperative bleeding.
Area of Science:
- Vascular anatomy
- Surgical anatomy
- Colorectal surgery
Background:
- The superior mesenteric vein (SMV) system is critical for colorectal surgery.
- Variations in colic vein drainage can complicate surgical procedures.
- Accurate anatomical knowledge is essential for safe and effective hemicolectomy.
Purpose of the Study:
- To evaluate the vascular anatomy of the right colic vein (RCV) and middle colic vein (MCV).
- To specifically focus on the confluence patterns of accessory colic veins (aRCV, aMCV) with the SMV and other vessels.
- To provide detailed anatomical insights for colorectal surgeons performing laparoscopic extended right hemicolectomy (Lap-ERHC).
Main Methods:
- Retrospective analysis of 100 patients undergoing Lap-ERHC.
- Detailed documentation of veins draining into the SMV: ileocecal vein (ICV), RCV, MCV, and gastrocolic trunk of Henle (GCT).
- Identification and classification of accessory colic veins (aICV, aRCV, aMCV) based on their drainage into non-SMV vessels.
Main Results:
- The gastrocolic trunk of Henle (GCT), aRCV, and aMCV were present in 86%, 89%, and 15% of patients, respectively.
- Accessory right colic veins (aRCVs) showed diverse drainage patterns, frequently involving the anterior superior pancreaticoduodenal vein (ASPDV) and GCT.
- Accessory middle colic veins (aMCVs) also exhibited varied drainage, including the GCT, splenic vein, and first jejunal vein (FJV).
Conclusions:
- The anatomical variations in colic vein confluences, particularly accessory vessels, are significant.
- This detailed vascular mapping offers critical information for colorectal surgeons.
- Awareness of these variations can aid in preventing intraoperative complications during Lap-ERHC.
Purpose:
To evaluate the right colic vascularity, focusing on the confluences of veins.
Methods:
The subjects of this retrospective study were 100 patients who underwent laparoscopic extended right hemicolectomy (Lap-ERHC) between April 2015 and September 2020, at our hospitals. Veins draining into the superior mesenteric vein (SMV) included the ileocecal vein (ICV), the right colic vein (RCV), the middle colic vein (MCV), and the gastrocolic trunk of Henle (GCT). Veins draining into vessels other than the SMV were defined as accessory colic veins (aICV, aRCV or aMCV).
Results:
The GCT, aRCV, and aMCV were found in 86, 89, and 15 patients, respectively. In 66 patients with one aRCV, drainage was split as the anterior superior pancreaticoduodenal vein (ASPDV) in 12, the right gastroepiploic vein (RGEV) in 7, and the GCT in 47. In 23 patients with two aRCVs, drainage was split as the ASPDV in 4, the RGEV in 1, the GCT in 11, and the ASPDV and GCT in 7. In 14 patients with one aMCV, drainage was split as the GCT in 8, the splenic vein in 5, and the first jejunal vein (FJV) in 1. One patient had two aMCVs, draining into the GCT and the FJV.
Conclusions:
The findings of our evaluation of vascular anatomy, focusing on confluences of the colic veins, provides useful information for colorectal surgeons.
More Related Videos
03:33Author Spotlight: Advancing Hepatobiliary and Pancreatic Tumor Treatment with Minimally Invasive Surgical Techniques
Published on: September 27, 2024
08:26Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023