Identification and management of hepatic artery variation in laparoscopic panc<b>-</b>reaticoduodenectomy: a report of 9 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FU Qihan , CHEN Pingping , ZENG Yongchao , TANG Rong , ZHANG Jiachao , LI Qijin , QIAO Xin ,  ZHANG Zhensheng

Department of Hepatobiliary and Pancreatic Surgery, Hainan Provincial People’s Hospital, Haikou 570311, P. R. China;

Corresponding author：

ZHANG Zhensheng, Email: 13876085818@163.com

Keywords：

laparoscopic pancreaticoduodenectomy; hepatic artery variation; typing

DOI：

10.7507/1007-9424.202304042

Video：

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Objective To explore the hepatic artery variations encountered in laparoscopic pancreaticoduodenectomy (LPD) surgery and its significance. Methods The clinical datas of 26 patients who underwent LPD from January 2020 to January 2023 were retrospectively collected. Preoperative evaluation of hepatic artery variability and its types based on relevant clinical and imaging data, as well as targeted measures taken during surgery, and patients’ prognosis were analyzed. Results According to preoperative abdominal enhanced CT, arterial computer tomography angiography imaging and intraoperative skeletonization of the hepatoduodenal ligament, hepatic artery variation was found in 9 of 26 patients undergoing LPD. The left hepatic artery was substituted in 1 case, the right hepatic artery was substituted in 2 cases, 2 cases were the left accessory hepatic artery, and the common hepatic artery originated from the superior mesenteric artery in 3 cases. There was 1 case, right hepatic artery coming from the abdominal aorta, whose arterial variation was not included in the traditional typing. The variant hepatic artery from superior mesenteric artery was separated by posterior approach during operation, and the variant hepatic artery from left gastric artery was separated by anterior approach during operation. Nine patients with hepatic artery variation recovered well after operation, and no serious complications occurred. Conclusions Various hepatic artery variations during LPD need to be carefully evaluated before surgery. During surgery, it should be determined whether to retain the mutated blood vessel based on its diameter and changes in liver blood flow after occlusion, so that reasonable operation can be performed during the operation to avoid hepatic artery damage.

Citation： FU Qihan, CHEN Pingping, ZENG Yongchao, TANG Rong, ZHANG Jiachao, LI Qijin, QIAO Xin, ZHANG Zhensheng. Identification and management of hepatic artery variation in laparoscopic panc-reaticoduodenectomy: a report of 9 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(9): 1037-1041. doi: 10.7507/1007-9424.202304042 Copy

1.	李佳, 彭创, 厉鸥, 等. 腹腔镜胰十二指肠切除围手术期动脉变异的处理策略. 中华肝胆外科杂志, 2018, 24(12): 838-842.
2.	王健, 谢敏, 包善华. 胰十二指肠切除术中肝动脉变异及意义. 中华胰腺病杂志, 2009, 9(4): 226-228.
3.	裘法祖, 王健本, 张祜曾. 腹部外科临床解剖学. 济南: 山东科学技术出版社, 2001: 138-146.
4.	Kaneko J, Ichida A, Kawaguchi Y, et al. Pancreaticoduodenectomy: how to handle a replaced right hepatic artery. Hepatobiliary Surg Nutr 2023, 12(2): 280-283.
5.	Malviya KK, Verma A. Importance of anatomical variation of the hepatic artery for complicated liver and pancreatic surgeries: A review emphasizing origin and branching. Diagnostics (Basel), 2023, 13(7): 1233.
6.	卢川, 刘作勤, 刘林祥, 等. 肝动脉解剖变异的DSA研究. 中国临床解剖学杂志, 2007, 25(4): 389-393.
7.	Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg, 1966, 112(3): 337-347.
8.	Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1 000 cases. Ann Surg, 1994, 220(1): 50-52.
9.	曾维, 颜杰, 等. 腹部CTA对肝动脉变异新分型的解剖学研究. 局解手术学杂志, 2022, 31(11): 937-942.
10.	袁晶, 陈蓉, 罗香国, 等. 肝动脉解剖变异的DSA与CTA对比分析. 重庆医学, 2009, 38(23): 2973-2974, 2977.
11.	Xu YC, Yang F, Fu DL. Clinical significance of variant hepatic artery in pancreatic resection: A comprehensive review. World J Gastroenterol, 2022, 28(19): 2057-2075.
12.	朱欣, 鲁葆春, 陈志良, 等. 腹腔镜胰十二指肠切除术患者肝动脉变异的识别与处理. 中华普通外科杂志, 2022, 37(1): 49-50.
13.	李家开, 张金山. 迷走肝动脉的DSA研究及临床意义. 临床放射学杂志, 2002, 21(3): 230-235.
14.	Pyras C, Lukas C, Janot-Matuschek M, et al. Preservation of aberrant right hepatic arteries does not affect safety and oncological radicality of pancreaticoduodenectomy—own results and a systematic review of the literature. Hepatobiliary Surg Nutr, 2022, 11(1): 25-37.
15.	Giani A, Mazzola M, Morini L, et al. Hepatic vascular anomalies during totally laparoscopic pancreaticoduodenectomy: challenging the challenge. Updates Surg, 2022, 74(2): 583-590.

1. 李佳, 彭创, 厉鸥, 等. 腹腔镜胰十二指肠切除围手术期动脉变异的处理策略. 中华肝胆外科杂志, 2018, 24(12): 838-842.
2. 王健, 谢敏, 包善华. 胰十二指肠切除术中肝动脉变异及意义. 中华胰腺病杂志, 2009, 9(4): 226-228.
3. 裘法祖, 王健本, 张祜曾. 腹部外科临床解剖学. 济南: 山东科学技术出版社, 2001: 138-146.
4. Kaneko J, Ichida A, Kawaguchi Y, et al. Pancreaticoduodenectomy: how to handle a replaced right hepatic artery. Hepatobiliary Surg Nutr 2023, 12(2): 280-283.
5. Malviya KK, Verma A. Importance of anatomical variation of the hepatic artery for complicated liver and pancreatic surgeries: A review emphasizing origin and branching. Diagnostics (Basel), 2023, 13(7): 1233.
6. 卢川, 刘作勤, 刘林祥, 等. 肝动脉解剖变异的DSA研究. 中国临床解剖学杂志, 2007, 25(4): 389-393.
7. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg, 1966, 112(3): 337-347.
8. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1 000 cases. Ann Surg, 1994, 220(1): 50-52.
9. 曾维, 颜杰, 等. 腹部CTA对肝动脉变异新分型的解剖学研究. 局解手术学杂志, 2022, 31(11): 937-942.
10. 袁晶, 陈蓉, 罗香国, 等. 肝动脉解剖变异的DSA与CTA对比分析. 重庆医学, 2009, 38(23): 2973-2974, 2977.
11. Xu YC, Yang F, Fu DL. Clinical significance of variant hepatic artery in pancreatic resection: A comprehensive review. World J Gastroenterol, 2022, 28(19): 2057-2075.
12. 朱欣, 鲁葆春, 陈志良, 等. 腹腔镜胰十二指肠切除术患者肝动脉变异的识别与处理. 中华普通外科杂志, 2022, 37(1): 49-50.
13. 李家开, 张金山. 迷走肝动脉的DSA研究及临床意义. 临床放射学杂志, 2002, 21(3): 230-235.
14. Pyras C, Lukas C, Janot-Matuschek M, et al. Preservation of aberrant right hepatic arteries does not affect safety and oncological radicality of pancreaticoduodenectomy—own results and a systematic review of the literature. Hepatobiliary Surg Nutr, 2022, 11(1): 25-37.
15. Giani A, Mazzola M, Morini L, et al. Hepatic vascular anomalies during totally laparoscopic pancreaticoduodenectomy: challenging the challenge. Updates Surg, 2022, 74(2): 583-590.

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Identification and management of hepatic artery variation in laparoscopic panc-reaticoduodenectomy: a report of 9 cases

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