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[Laparoscopic pancreaticoduodenectomy with a novel artery first and uncinate process first approach through Treitz ligament].
Zhonghua Wai Ke Za Zhi. 2017 May 01; 55(5):359-363.ZW

Abstract

Objective:

To explore the clinical effect of a novel artery first and uncinate process first approach for laparoscopic pancreaticoduodenectomy(LPD), emphasizing the left lateral and posterior dissection of uncinate process (UP) via Treitz ligament approach.

Methods:

From April to November 2016, 18 patients received LPD with a novel approach in Pancreas Center of the First Affiliated Hospital with Nanjing Medical University. All patients were diagnosed as pancreatic head or peri-ampulla tumor, without major vessel invasion nor distant metastasis. For resection, routine caudal view was used in the first step, to dissect the anterior medial border between uncinate process and superior mesenteric vein(SMV). Lymphatic tissues were completely dissected form anterior surface of hepatoduodenal ligament. In the second step, left lateral view with camera from left para-umbilical trocar was used, Treitz ligament was incised, SMA root was exposed. After anticlockwise rotation and retraction of mesentery, the anatomic relationship between SMA trunk, inferior pancreaticoduodenal artery(IPDA), jejunal branch of SMV, and distal part of UP, could be perfectly exposed from left lateral view. SMA was dissected from its root until the position above the uncinate process and duodenum, IPDA was transected, distal part of UP was freed from SMA. In the third step, right lateral view and caudal view were alternatively used; proximal UP mesentery was completely dissected out from SMA root, CA root and posterior surface of hepatoduodenal ligament. Pancreaticoduodenectomy was completed in the forth step after transection of pancreatic neck and common hepatic duct.

Results:

The SMA root and distal UP were successfully dissected out via Treitz ligament approach in all 18 patients, among them, distal UP was completely excised in 8 patients from left view. Postoperative pathology showed R0 resection rate in 69%. Postoperative complication included intra-abdominal hemorrhage in 1 patient, pancreatic fistula in 7 patients(6 cases with grade A and 1 case with grade B), delayed gastric emptying in 4 patients (2 cases with grade A, 2 cases with grade B). Average postoperative hospital stay was (15.5±6.8)days.

Conclusion:

The novel artery first and uncinate process first approach through Treitz ligament could help surgeons to completely dissect the full length of meso-pancreas along celiac axis-SMA axis in LPD.

Authors+Show Affiliations

Pancreas Center, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

chi

PubMed ID

28464576

Citation

Gao, W T., et al. "[Laparoscopic Pancreaticoduodenectomy With a Novel Artery First and Uncinate Process First Approach Through Treitz Ligament]." Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery], vol. 55, no. 5, 2017, pp. 359-363.
Gao WT, Xi CH, Tu M, et al. [Laparoscopic pancreaticoduodenectomy with a novel artery first and uncinate process first approach through Treitz ligament]. Zhonghua Wai Ke Za Zhi. 2017;55(5):359-363.
Gao, W. T., Xi, C. H., Tu, M., Dai, X. L., Guo, F., Chen, J. M., Wei, J. S., Lu, Z. P., Wu, J. L., Jiang, K. R., & Miao, Y. (2017). [Laparoscopic pancreaticoduodenectomy with a novel artery first and uncinate process first approach through Treitz ligament]. Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery], 55(5), 359-363. https://doi.org/10.3760/cma.j.issn.0529-5815.2017.05.010
Gao WT, et al. [Laparoscopic Pancreaticoduodenectomy With a Novel Artery First and Uncinate Process First Approach Through Treitz Ligament]. Zhonghua Wai Ke Za Zhi. 2017 May 1;55(5):359-363. PubMed PMID: 28464576.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Laparoscopic pancreaticoduodenectomy with a novel artery first and uncinate process first approach through Treitz ligament]. AU - Gao,W T, AU - Xi,C H, AU - Tu,M, AU - Dai,X L, AU - Guo,F, AU - Chen,J M, AU - Wei,J S, AU - Lu,Z P, AU - Wu,J L, AU - Jiang,K R, AU - Miao,Y, PY - 2017/5/3/entrez PY - 2017/5/4/pubmed PY - 2017/8/8/medline KW - Laparoscopy KW - Pancreaticoduodenectomy KW - Superior mesenteric vein KW - Treitz ligament KW - Uncinate process first SP - 359 EP - 363 JF - Zhonghua wai ke za zhi [Chinese journal of surgery] JO - Zhonghua Wai Ke Za Zhi VL - 55 IS - 5 N2 - Objective: To explore the clinical effect of a novel artery first and uncinate process first approach for laparoscopic pancreaticoduodenectomy(LPD), emphasizing the left lateral and posterior dissection of uncinate process (UP) via Treitz ligament approach. Methods: From April to November 2016, 18 patients received LPD with a novel approach in Pancreas Center of the First Affiliated Hospital with Nanjing Medical University. All patients were diagnosed as pancreatic head or peri-ampulla tumor, without major vessel invasion nor distant metastasis. For resection, routine caudal view was used in the first step, to dissect the anterior medial border between uncinate process and superior mesenteric vein(SMV). Lymphatic tissues were completely dissected form anterior surface of hepatoduodenal ligament. In the second step, left lateral view with camera from left para-umbilical trocar was used, Treitz ligament was incised, SMA root was exposed. After anticlockwise rotation and retraction of mesentery, the anatomic relationship between SMA trunk, inferior pancreaticoduodenal artery(IPDA), jejunal branch of SMV, and distal part of UP, could be perfectly exposed from left lateral view. SMA was dissected from its root until the position above the uncinate process and duodenum, IPDA was transected, distal part of UP was freed from SMA. In the third step, right lateral view and caudal view were alternatively used; proximal UP mesentery was completely dissected out from SMA root, CA root and posterior surface of hepatoduodenal ligament. Pancreaticoduodenectomy was completed in the forth step after transection of pancreatic neck and common hepatic duct. Results: The SMA root and distal UP were successfully dissected out via Treitz ligament approach in all 18 patients, among them, distal UP was completely excised in 8 patients from left view. Postoperative pathology showed R0 resection rate in 69%. Postoperative complication included intra-abdominal hemorrhage in 1 patient, pancreatic fistula in 7 patients(6 cases with grade A and 1 case with grade B), delayed gastric emptying in 4 patients (2 cases with grade A, 2 cases with grade B). Average postoperative hospital stay was (15.5±6.8)days. Conclusion: The novel artery first and uncinate process first approach through Treitz ligament could help surgeons to completely dissect the full length of meso-pancreas along celiac axis-SMA axis in LPD. SN - 0529-5815 UR - https://www.unboundmedicine.com/medline/citation/28464576/[Laparoscopic_pancreaticoduodenectomy_with_a_novel_artery_first_and_uncinate_process_first_approach_through_Treitz_ligament]_ L2 - http://journal.yiigle.com/LinkIn.do?linkin_type=pubmed&issn=0529-5815&year=2017&vol=55&issue=5&fpage=359 DB - PRIME DP - Unbound Medicine ER -