Background:According to previous guidelines,the lymph nodes around the right side of the superior mesenteric artery(SMA)should be dissected and removed en bloc.However,due to the technical challenge and the risk of co...Background:According to previous guidelines,the lymph nodes around the right side of the superior mesenteric artery(SMA)should be dissected and removed en bloc.However,due to the technical challenge and the risk of complications,most surgeons perform the dissection along the axis of the superior mesenteric vein(SMV).Herein,we described an‘artery-first’approach for laparoscopic radical extended right hemicolectomy with complete mesocolic excision(CME).Methods:A total of 22 cases were collected from January to October 2016.The right side of the SMA and SMV were exposed and separated,and the No.203,No.213 and No.223 lymph nodes were dissected en bloc.Toldt’s fascia was dissected and expanded laterally to the ascending colon,cranial to the pancreas head.The caudal root of the mesentery and lateral attachments of the ascending colon were completely mobilized.Results:There were 9 male and 13 female patients,with a mean age of 63.1(range,39–83)years and the mean body mass index was 24.6(range,18.3–37.7)kg/m^(2).The mean operative time was 192.5(range,145–240)minutes and the mean intraoperative blood loss was 55.0(range,10–300)ml.The mean number of harvested lymph nodes was 27.0(range,13–55)and the time to flatus and hospital stay were 35.0(range,26–120)hours and 7.5(range,5–20)days,respectively.Minor complications occurred in two patients and no post-operative death was observed.Conclusions:The preliminary results suggest that the reported approach may be a feasible and safe procedure that is more in accordance with the principles of CME.展开更多
Pancreaticoduodenectomy(PD) is the standard surgical treatment for tumors of the pancreatic head,proximal bile duct,duodenum and ampulla,and represents the only hope of cure in cases of malignancy.Since its initial de...Pancreaticoduodenectomy(PD) is the standard surgical treatment for tumors of the pancreatic head,proximal bile duct,duodenum and ampulla,and represents the only hope of cure in cases of malignancy.Since its initial description in 1935 by Whipple et al,this complex surgical technique has evolved and undergone several modifications.We review three key issues in PD:(1) the initial approach to the superior mesenteric artery,known as the artery-first approach;(2) arterial complications caused by anatomic variants of the hepatic artery or celiac artery stenosis;and(3) the extent of lymphadenectomy.展开更多
文摘Background:According to previous guidelines,the lymph nodes around the right side of the superior mesenteric artery(SMA)should be dissected and removed en bloc.However,due to the technical challenge and the risk of complications,most surgeons perform the dissection along the axis of the superior mesenteric vein(SMV).Herein,we described an‘artery-first’approach for laparoscopic radical extended right hemicolectomy with complete mesocolic excision(CME).Methods:A total of 22 cases were collected from January to October 2016.The right side of the SMA and SMV were exposed and separated,and the No.203,No.213 and No.223 lymph nodes were dissected en bloc.Toldt’s fascia was dissected and expanded laterally to the ascending colon,cranial to the pancreas head.The caudal root of the mesentery and lateral attachments of the ascending colon were completely mobilized.Results:There were 9 male and 13 female patients,with a mean age of 63.1(range,39–83)years and the mean body mass index was 24.6(range,18.3–37.7)kg/m^(2).The mean operative time was 192.5(range,145–240)minutes and the mean intraoperative blood loss was 55.0(range,10–300)ml.The mean number of harvested lymph nodes was 27.0(range,13–55)and the time to flatus and hospital stay were 35.0(range,26–120)hours and 7.5(range,5–20)days,respectively.Minor complications occurred in two patients and no post-operative death was observed.Conclusions:The preliminary results suggest that the reported approach may be a feasible and safe procedure that is more in accordance with the principles of CME.
文摘Pancreaticoduodenectomy(PD) is the standard surgical treatment for tumors of the pancreatic head,proximal bile duct,duodenum and ampulla,and represents the only hope of cure in cases of malignancy.Since its initial description in 1935 by Whipple et al,this complex surgical technique has evolved and undergone several modifications.We review three key issues in PD:(1) the initial approach to the superior mesenteric artery,known as the artery-first approach;(2) arterial complications caused by anatomic variants of the hepatic artery or celiac artery stenosis;and(3) the extent of lymphadenectomy.
