Can the transection plane be optimized in pancreatic resections?

Area of Science:

• Surgical Anatomy
• Medical Imaging
• Pancreatic Surgery

Background:

• Current pancreatic resection protocols typically transect at the superior mesenteric vein (SMV).
• Existing research suggests modifying resection planes for specific conditions like portal annular pancreas.
• The optimal resection line may vary in other pancreatic pathologies.

Purpose of the Study:

• To simulate pancreatic resections along various planes.
• To identify the optimal resection line minimizing transected vessels.
• To evaluate alternative resection planes beyond the standard SMV level.

Main Methods:

• Utilized 25 abdominal vascular corrosion casts.
• Performed CT scans on casts after cannulating the aorta and portal vein.
• Reconstructed specific planes to simulate different resection lines and calculated vessel cross-sections.

Main Results:

• Optimal resection planes were identified: SMV (11/25), 2 cm left of SMV (10/25), 1 cm left of SMV (4/25), and 1 cm right of SMV (1/25).
• Left-sided extensions of the resection plane occurred in over half of the cases.
• Left-sided resections reduced the cut surface area of vessels by up to 29% compared to the SMV plane.

Conclusions:

• Pancreatic resections frequently necessitate extension to the left of the SMV.
• Preoperative imaging, utilizing tools like DICOM viewers with multiplanar reconstruction, is crucial for determining optimal resection planes.
• Simulating resection planes preoperatively can significantly reduce the risk of postoperative bleeding.