The value of ICG-guided left colon vascular variation and anatomical rules for the radical resection of proctosigmoid colon cancer.

Objective: During laparoscopic radical resection for proctosigmoid colon cancer (PCC), surgeons could inadvertently damage the arteries when following the operation path.This study investigated the variations in left colon blood vessels in order to guide the scientific protection of the marginal artery (MA) during laparoscopic surgery for PCC. Methods: Data from seven patients who underwent inferior mesenteric artery (IMA) angiography were included as imaging references to preliminarily explore the vascular structure and variation in the left colon. The clinical video data of 183 PCC patients were retrospectively analyzed to observe intraoperative MA injury. Meanwhile, a prospective cohort of 96 patients with the same disease underwent intraoperative indocyanine green (ICG) fluorescence imaging of the peripheral sigmoid artery network, the variation of marginal arteries was summarized, and the distance between vessels and the bowel was measured at different levels. Patients were divided into 'ICG group' and 'non-ICG group' according to whether ICG guidance was performed, and perioperative conditions were compared between the two groups. Taking the integrity of lymph node dissection into consideration, 18 patients underwent carbon nanonode tracing. This study was conducted under the standard consent and ethical approval of the Ethics Committee of our center. Results: 7 patients with IMA angiography shared some vascular structures, defined as 'Dangerous Triangle' and 'Secure Window'. Through intraoperative observation, the primary arch was typically located 4.2 (2.3-6.0) cm away from the intestinal canal, and 5.21% (5/96) patients had poor anastomosis at the primary arch. Moreover, secondary vascular arches (6.4 (4.6-10.0) cm from the intestinal wall) were observed in 38.54% of patients. MA injury was identified in 2 of 183 cases, and the ischemic bowel was timely dissected, whereas no such injury occurred during ICG fluorescenceguided surgery. Guided by carbon nanoparticles, the integrity of lymph node dissection can be maintained while preserving the secondary arch in all patients. Conclusions: This study demonstrated the benefits of ICG guidance in protecting the intestinal blood supply in laparoscopic PCC surgery. By enhancing the understanding of primary and secondary vascular arches, secure windows, and dangerous triangles, surgeons can safely optimize the surgical path during surgery.

A Unique Arc of Bühler Variant Connecting the Arteries of the Foregut, Midgut, and Hindgut and Its Surgical Significance.

This case report presents a rare variation of the arc of Bühler (AOB) in a cadaver during the abdominal dissection assignment in the Ross Anatomy Lab at William Carey University College of Osteopathic Medicine. The AOB is a patent anastomotic channel between the celiac trunk and the superior mesenteric artery independent of the gastroduodenal artery and dorsal pancreatic artery. This report describes in detail a complex and extensive branching pattern of a unique AOB variant. Our findings contribute to the limited literature on this condition and emphasize the importance of thorough knowledge of vascular variations to avoid potential complications during surgical procedures.

Anatomical study about the variations in renal vasculature.

Renal vascularization is classically described as a renal artery and vein. However, this vascular pattern presents numerous anatomical variations in terms of their number, origin and course due to ontogenetic alterations. The aim was to carry out a descriptive study of the renal vascular pattern observed during the dissection of cadavers intended for teaching purposes. A descriptive and observational study of renal vascular anatomy was carried out by dissecting 16 renal blocks from 8 cadavers donated to science and used for teaching at the Faculty of Medicine of the University of Zaragoza. The prevalence of arterial variations was 75% (56.3% for polar renal arteries, 12.5% for pre-hilar branching and 6.25% for double communicating arterial arch) and venous was 62.5% (12.5% for polar renal veins, 25% for late venous confluence, 6.25% for triple renal vein and 18.75% for double circumaortic renal vein). We conclude that the renal vascular anomalies occur with high frequency; for this reason, knowledge of these anomalies is extremely important for the correct planning of numerous medical-surgical activities.

Variation of the ileocolic artery and superior mesenteric artery in a patient with right-sided colon cancer with Lynch syndrome: a case report.

Background: Complete mesangectomy and central vascular detachment are the core elements of laparoscopic right hemicolectomy. Failure to identify vascular variations in patients undergoing laparoscopic right hemicolectomy can result in unwanted bleeding, a prolonged surgical time, transfer to open surgery, and an elevated risk of postoperative complications. In this case report, we describe a new vascular variation that has not yet been reported in the literature. Parallelly vascular variation and the management of vessels in key areas are essential for successful surgery. Case Description: The patient was a 32-year-old female who was referred to the department of gastrointestinal surgery of our hospital due to intermittent abdominal pain accompanied by changes in stool habits for 3 months. She had not experienced other symptoms. Physical examination revealed mild tenderness in the right lower abdomen. Subsequently, she underwent laparoscopic radical right hemicolectomy for ascending colon cancer under general anesthesia in our hospital. Preoperative abdominal contrast-enhanced computed tomography (CT) and intraoperative photos confirmed that there were two ileocolic arteries derived from the superior mesenteric artery (SMA). On the other side, the SMA and superior mesenteric vein (SMV) were found to be accompanied like "X"-shaped variant. The final surgical pathological diagnosis was pT3N1aM0 adenocarcinoma of the ascending colon. Given the patient's family history of colon and uterine cancer combined with the results of immunohistochemical staining and next-generation sequencing, we concluded that she had Lynch syndrome (LS). Conclusions: This report describes the first case of simultaneous variation of the ileocolic artery (ICA) and SMA in a female patient with colon cancer. This type of vascular variation should be fully recognized by surgeons in order to avoid unnecessary intraoperative bleeding.

Pancreaticoduodenal and choledochal hemangiomatosis with vascular variation in a child: a rare disease with challenge starts from diagnosis-a case report.

BACKGROUND: Visceral hemangiomatosis is a benign tumor (rarer than hemangioma) that has not been reported to occur in the pancreas, duodenum, or choledoch. It can be easily confused with other pancreatic tumors or choledocholithiasis. Herein, we describe a case of a child with pancreaticoduodenal and choledochal hemangiomatosis and the key characteristics for the accurate diagnosis of pancreatic tumors based on previous reports and our findings. CASE PRESENTATION: We report a case of a 2-year and 9-month-old child who presented with repeated and fluctuating jaundice for 3 months with a history of endoscopic stone removal in a local hospital, following the diagnosis of choledocholithiasis. An abdominal computed tomography revealed a previously undiagnosed pancreatic head tumor and celio-mesenteric trunk (a rare vascular variation). This was misdiagnosed as a pancreatic neuroendocrine tumor. Since the patient's parents refused FNA biopsy and insisted on surgery, pancreaticoduodenectomy was performed; however, postoperatively, the child was correctly diagnosed with pancreaticoduodenal and choledochal hemangiomatosis. Although the patient was in good condition and had gained 4 kg in weight 3 months postoperatively, pancreaticoduodenectomy could have been avoided if an accurate diagnosis had been established before or during the operation. CONCLUSION: Our report highlights the difficulty in diagnosing visceral hemangiomatosis. Radiologists, endoscopists, and surgeons should consider this possibility in cases of repeated and fluctuating jaundice that cannot be explained by choledocholithiasis alone.

Clinical significance of aberrant left hepatic artery during gastrectomy: A systematic review.

BACKGROUND: Vascular variations are frequently encountered during surgery. Approximately thirty percent of these variations are aberrant left hepatic arteries originating from the left gastric artery. AIM: To summarize the safety and feasibility of aberrant left hepatic arteries (ALHA) ligation in gastric cancer patients who underwent laparoscopic-assisted gastrectomy (LAG). METHODS: The literature search was systematically performed on databases including PubMed, Embase, and Cochrane Library. The publishing date of eligible studies was from inception to June 2021. RESULTS: A total of nine studies were included according to the inclusion and exclusion criteria in this review. The variation rate of ALHA ranged from 7.00% to 20.70%, and four studies compared the differences between the ALHA ligation group and the preservation group. Only one study showed worse postoperative outcomes in the ALHA ligation group. In all the included studies, a significant difference was found between the ALHA ligation group and the preservation group in terms of postoperative liver enzymes after LAG. However, there was no significant difference in the number of retrieved lymph nodes between the two groups. CONCLUSION: In conclusion, it is not always safe and feasible for surgeons to ligate the ALHA during LAG surgery, and it is necessary for gastric cancer patients to undergo preoperative examination to clarify the ALHA subtypes, measure the diameter of the ALHA, and determine whether the patients have chronic liver disease.

Vascular variations encountered during laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer: a retrospective cohort study.

BACKGROUND: Laparoscopic surgery for cancer located in the transverse colon or splenic flexure is difficult because of vascular variability in this region and adjacent vital organs such as the pancreas, spleen, and duodenum. METHODS: This retrospective cohort study involved 51 patients who underwent laparoscopic surgery for colon cancer at Tokushima University Hospital from July 2015 to December 2020. Variations of the middle colic artery (MCA), left colic artery (LCA), middle colic vein (MCV), and first jejunal vein (FJV) and short-term outcomes of laparoscopic surgery in patients with each vascular variation were evaluated. RESULTS: Variations of the MCA, LCA, MCV, and FJV were classified into four, three, five, and three patterns, respectively. The short-term outcomes of laparoscopic surgery for transverse colon cancer in patients with MCA variations and those with FJV variations were evaluated, and no significant difference was found in the operation time, blood loss, postoperative complication rate, time from surgery to start of dietary intake, or time from surgery to discharge among the different variations. Additionally, no significant differences were found in the short-term outcomes of laparoscopic surgery for descending colon cancer in patients with LCA variations. CONCLUSION: Preoperative assessment of vascular variations may contribute to the stability of short-term outcomes of laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer.

Anatomical Variations of Vascular Anatomy in Meckel's Diverticulum.

OBJECTIVE: The objective of the current study was to describe the anatomical variations of vessels observed in patients with Meckel's Diverticulum. METHODS: A narrative review of the literature was undertaken by means of the PubMed database, using the terms: "Meckel's Diverticulum AND vessels", "Meckel's Diverticulum AND anatomical variation" and "Meckel's Diverticulum variation". Classical anatomical textbooks were also used for normal anatomy. Additional articles provided useful information in relation to the aim of this review. Hence, the articles that met the inclusion criteria were included in this review, and the collected data were categorized into a single table. RESULTS: The majority of studies indicated the presence of an abnormal vitelline artery. Other angiographic findings concerned variations of the ileal and the iliac arteries. However, the literature revealed the presence of vascular variations without the existence of Meckel's Diverticulum, whereas a remnant of the vitelline vein may be present, but it is very rare. CONCLUSION: The detection of vascular variations accompanying Meckel's Diverticulum is not always easy and requires the correct choice of imaging method to prevent misdiagnosis.

An unusual topographic relationship between high origin of superficial ulnar artery and bitendinous palmaris longus.

The ulnar artery usually arises from the brachial artery at the cubital fossa. It descends beneath the flexor carpi ulnaris in the forearm and then terminates at the wrist joint by forming the superficial palmar arch with the contributory radial artery. In the present study, we report a more proximal origin of ulnar artery presenting a superficial course in the lower portion of the upper extremity, termed superficial ulnar artery. Interestingly, this artery lies superficially to a bitendinous palmaris longus, a variant muscle in the forearm. The relation between arterial and muscular variations may be useful during clinical procedures such as angiography, forearm flap and tendon grafting as well as avoiding accidental intra-arterial injection.

Sequential analysis of single-center experience of living donor kidney transplants with several vascular anastomosis techniques

Background and aim: Vascular variations of grafts are handled with various reconstruction techniques in renal transplantation. We aimed to analyze the effects of these reconstruction techniques and sites on patient/graft outcomes. Materials and methods: Renal transplantation cases at the Transplantation Unit of the General Surgery Department, Istanbul Uni- versity Cerrahpasa Medical Faculty between January 1st, 2000 and December 31st, 2012 were analyzed retrospectively. Postoperative duplex ultrasound results, urea-creatinine reduction rates, and complications were evaluated. Results: There were 228 living-donor transplantation cases evaluated. For single-renal-artery living-donor transplantations, there were 45 end-to-side external iliac artery, 15 end-to-side internal iliac artery, 152 end-to-end internal iliac artery, and 3 end-to-side common iliac artery anastomoses performed. In cases with double-arteries, 3 had end-to-side external iliac artery anastomoses, and 10 had end- to-end internal iliac artery anastomoses. No statistically significant differences were found between reconstruction techniques with regard to complications or urea-creatinine reduction rates. Conclusion: Internal, external, and common iliac arteries can be safely used for anastomoses. The presence of more than one renal artery creates no short or long-term problems when a side-to-side anastomosis is initially performed.

Vertebrobasilar Junction Angle Over 90°: A Potential Imaging Marker Associated With Vertebrobasilar Atherosclerosis.

Objective: Whether the cerebral vascular variations play an important role in the progression of intracranial atherosclerosis is yet largely unclear. We aimed to investigate the relationship between the magnitude of the vertebrobasilar junction (VBJ) angle and the imaging features of vertebrobasilar artery atherosclerosis. Methods: Adult patients with acute ischemic stroke or transient ischemic attack undergoing a 3.0-tesla vessel wall magnetic resonance imaging (VW-MRI) scanning were consecutively included. Imaging features of vertebrobasilar artery atherosclerosis were assessed on the reconstructed short axis of VW-MRI at the most stenotic site. The VBJ angle degree was measured on magnetic resonance angiography and classified into the angle ≥90° or <90°. Results: Among 68 patients (mean age = 63.5 ± 9.4 years old; 63.2% were male) with vertebrobasilar atherosclerosis, 33 had a VBJ angle ≥90° and 35 had a VBJ angle <90°. Compared to the vertebrobasilar plaques with VBJ angle <90°, those with VBJ angle ≥90° had a heavier plaque burden (84.35 vs. 70.58%, p < 0.001) and higher prevalence of intraplaque hemorrhage (17.1 vs. 3.3%, p = 0.01). In the regression analyses, the VBJ angle ≥90° was also robustly associated with plaque burden (odds ratio, 1.11; 95% confidential interval, 1.043-1.18; p = 0.001) and intraplaque hemorrhage (odds ratio, 5.776; 95% confidential interval, 1.095-30.46; p = 0.039) of vertebrobasilar atherosclerosis. Conclusion: The VBJ angle over 90° might aggravate the vessel wall condition of the atherosclerotic vertebrobasilar arteries, which might serve as a potential risk factor for vertebrobasilar atherosclerosis.

Clinical value of conventional ultrasound and contrast-enhanced ultrasound in evaluating donor liver quality in liver transplantation / 器官移植

At present, a large quantity of patients with end-stage liver diseases are still waiting for liver transplantation. Evaluation of donor liver quality with rapid, convenient, non-invasive and accurate methods plays a pivotal role in improving the prognosis and quality of life of liver transplant recipients. No standard evaluation criteria of donor liver quality have been established in clinical practice. Comprehensive evaluation methods have been primarily adopted, including clinical parameters of donors, laboratory examination, imaging examination and pathological examination, etc. Conventional ultrasound and contrast-enhanced ultrasound may evaluate the quality of donor liver before liver transplantation and predict the incidence of complications after liver transplantation, which are of significant application prospect in liver transplantation. In this article, the basic methods and research progress on conventional ultrasound and contrast-enhanced ultrasound in evaluating the vascular variation of donor liver, micro-circulatory perfusion of liver parenchyma, degree of steatosis of donor liver, degree of fibrosis of donor liver, volume and quality of donor liver were reviewed, aiming to provide more methods and ideas for clinical evaluation of donor liver quality.

Anatomical variants of anterior communicating artery complex. A study by Computerized Tomographic Angiography.

Advances in imaging techniques have led to the identification of normal variations and abnormalities of cerebral arteries. Although the anterior communicating artery complex (ACAC) variations are usually asymptomatic, their description is essential in the radiologic report, since they can have clinical relevance. The aim of this study is to describe arterial anomalies of the ACAC and their prevalence. A retrospective observational descriptive analysis of ACAC variations in Computerized Tomographic Angiography (CTA) was performed. All CTA (426 studies) obtained in our center from 2015 to 2017 were included. Presence of aneurysm was recorded and its relationship with arterial variants was analyzed with a Chi-square test. The most common variants found in our study are linked to the A1 segment (42.3%) of the anterior cerebral artery (ACA): absence: 10.6%, hypoplasia: 31.2%, fenestration: 0.5%. A2 segment variants were present in 15.3% (absence: 0.2%; hypoplasia 8.5%; Azygos artery: 1.4%; triple ACA: 5.2%). Anterior Communicanting Artery was typical in 92.5%, absent in 4.7%, double/fenestrated in 0.9%, triple in 0.2%, X-shape in 1.2% and Y-shape in 0.2%. Aneurysms were present in 10.7%. Anterior circulation aneurysm involved the 50% of patients with aneurysm. Although the 60.9% of them showed artery variants, they did not reach statistical significance (p = 0.6). In conclusion, the Anterior Communicating Artery Complex presents variations in its anatomy. The most common anterior circulation vascular variants are the hypoplasia and the absence of the A1 segment. There does not appear to be a clear association between intracranial aneurysms and anatomical variations.

Hepatic vascular variations and visual three-dimensional reconstruction technique in pediatric patients with choledochal cyst.

PURPOSE: The aim of the present study was to identify the hepatic vascular variations with visual three-dimensional (3D) reconstruction of vessels in pediatric patients with choledochal cyst (CDC). METHODS: We retrospectively analyzed the data of 84 children with pathologically confirmed CDCs treated in the Children's Hospital of Soochow University. 180 patients without CDCs as a control to analysis the hepatic artery and portal vein anatomy. All patients were examined by multi-slice spiral CT (MSCT) and the images of children with CDC were reconstructed by Hisense computer-assisted surgery system (Hisense CAS) to obtain visual 3D images. RESULTS: There were 71 females and 13 males diagnosed with CDC. According to Todani classification of CDC, there were 42 cases of type Ia, 10 cases of type Ic and 32 cases of type IVa. There were 10 (11.9%) patients with hepatic artery variations, 14 (16.7%) patients with right hepatic artery located on the ventral side of the CDC, and 16 (19.0%) patients with portal vein variations. Sex, age and types of the cyst were not associated with the presence of vascular variations. There was no significant difference in hepatic vascular variation between CDCs and control groups. Visual 3D images clearly displayed the hepatic vascular variations and the spatial structure of the CDC in pediatric patients with CDC. CONCLUSIONS: Hepatic artery and portal vein variations can be detected in pediatric patients with CDC. Visual 3D technique can visually and stereoscopically display the anatomical variations of the hepatic artery and portal vein.

The Short-Term Outcomes of Gastric Cancer Patients Based on a Proposal for a Novel Classification of Perigastric Arteries.

PURPOSE: To establish a novel classification of perigastric arteries by computerized tomography angiography (CTA) and discuss its influence in patients' short-term clinical outcomes. METHODS: The clinical data were analyzed retrospectively from 680 gastric cancer patients. The types of the perigastric artery were classified according to CTA image and we compared the short-term clinical outcomes. RESULTS: The perigastric arteries can be divided into seven categories. Type I, trifurcation of the celiac trunk (CT) (294/343, 85.7%); type II, hepatosplenic trunk, left gastric artery (LGA) arising from the abdominal aorta (8/343, 2.3%); type III, hepatogastric trunk, splenic artery arising from the superior mesenteric artery (SMA) (2/343, 0.6%); type IV, celiacomesenteric trunk (5/343, 1.5%); type V, common hepatic artery (CHA) arising from the SMA, gastrosplenic trunk (11/343, 3.2%); type VI, aberrant (accessory or replaced) left hepatic artery arising from LGA (21/343, 6.1%); and type VII, CHA arising from LGA (2/343, 0.6%). The number of retrieved LNs in the CTA group was significantly higher than that in the non-CTA group. However, the operation time, estimated blood loss, intraoperative vascular injury, and medical cost of the CTA group were significantly less than those in the non-CTA group. Of note, in patients with BMI ≥ 25.0, higher LNs retrieval and less vascular injury were still present in the CTA group, which was of vital importance in clinical practice. Furthermore, the CTA group displayed shorter hospital stay (LOS). CONCLUSION: We established a new perigastric artery classification. Application of the classification can improve the short-term clinical outcomes of patients.

Massive hemobilia due to a ruptured mycotic hepatic artery aneurysm associated with streptococcal endocarditis: case report.

Hepatic artery aneurysm rupture is a rare cause of massive hemobilia, which is potentially life-threatening, cause of upper gastrointestinal hemorrhage. Cases of mycotic hepatic artery aneurysm associated with streptococcal endocarditis have rarely been reported. In the present study, we report a case of massive hemobilia that was caused by ruptured mycotic hepatic artery aneurysm in a patient who was infected with streptococcal endocarditis 3 months previously. Transarterial embolization in the patient failed, possibly due to vascular variations. However, surgical treatment was successfully performed, and the patient completely recovered. In conclusion, surgical treatment may be useful in treating massive hemobilia under life-threatening conditions, even in cases of vascular variations and failure of transarterial embolization.

Use of Hisense Computer-Assisted Surgery System Enhances Infrapyloric Lymph Node Dissection for Gastric Cancer.

BACKGROUND: This study aimed to establish a three-dimensional model of infrapyloric vessels using the Hisense computer-assisted surgery (CAS) system before the operation to understand blood vessel variation types and determine the group 6 lymph node (LN) metastasis status. METHODS: One hundred and four gastric cancer patients were randomly assigned to a CAS group and a computed tomography (CT) group. Intraoperative and postoperative complications in the two groups were recorded. The number of group 6 LNs dissected and the metastasis status were compared between the groups. The independent risk factors influencing group 6 LN metastasis were determined by multiple logistic regression analysis. RESULTS: In the 50 CAS group patients, the gastrocolic trunk of Henle was divided into a gastrocolic type (34.0%) and a gastropancreatic colonic type (66.0%); the right gastroepiploic artery was divided into a coarse blood supply type (24.0%) and a fine blood supply type (76.0%); and the relationship between the right gastroepiploic artery and right gastroepiploic vein was divided into an adjacent type (58.0%) and a separated type (42.0%). Although the difference was not significant, the CAS group had fewer cases of intraoperative gastrocolic trunk injury and postoperative pancreatic leakage in trend than the CT group. The CAS group had more dissected LNs (P < 0.001) and metastatic LNs (P = 0.011) than the CT group; meanwhile, it had higher LN metastasis rate and LN metastasis degree in trend than the CT group. According to the multiple logistic regression model, tumor location and TNM stage were significantly correlated with group 6 LN metastases. CONCLUSIONS: By establishing a three-dimensional model of the infrapyloric vessels using the Hisense CAS system, we comprehensively determined the anatomic variations in each collateral vessel. The application of the Hisense CAS system significantly improved the number of LNs dissected and the discovery rate of LN metastases without increasing the incidence of complications.

Microvascular Decompression in Patients Aged 30 Years or Younger.

OBJECTIVE: The aim of this study was to identify the etiology of hemifacial spasm (HFS) and trigeminal neuralgia (TN) in patients aged 30 years or younger and to examine the efficacy of microvascular decompression (MVD). PATIENTS AND METHODS: Between 1996 and 2012, 228 HFS and 190 TN patients underwent MVD at Atsuchi Neurosurgical Hospital. Of these, 7 patients were 30 years of age or younger at the time of treatment (HFS: n = 6, TN: n = 1). Assessments were based on their medical history and on magnetic resonance imaging, magnetic resonance angiography, surgical, and follow-up findings. RESULTS: The age of the 6 HFS patients ranged from 23 to 30 years (mean 27.8 ± 1.8 [standard deviation] years) at the time of surgery; the earliest symptom onset was in an 11-year-old boy. We noted vascular variations in 5 patients, a duplicate posterior inferior cerebellar artery in 2 patients, a short basilar artery in 1 patient, and an aberrant arterial course in 2 patients. At the latest follow-up, 1-69 months after MVD, 5 of the HFS patients were asymptomatic and the 6th had mild residual symptoms. A 23-year-old TN female underwent straightening of the trigeminal nerve by separation of a thickened arachnoid membrane from the nerve and dislocation of a small branch of the superior cerebellar artery from the distal end of the root exit zone. While she continued to experience occasional facial pain 48 months after the operation, she required no medication because surgery yielded significant pain amelioration. CONCLUSION: Although the pathogenesis of early-onset HFS and TN remains unclear, our findings suggest that vascular variations may be related to the etiology of vascular compression symptoms in patients with HFS or TN. MVD was useful for the treatment of neurovascular compression symptoms in young patients.

Approaches in the treatment of vascular variation by robot-assisted pancreatic surgery / 中华胰腺病杂志

Da Vinci robot has been widely used in pancreatic surgery nowadays. Pancreatic surgery is known as a difficult procedure in general surgery due to its surgical difficulty, complex anatomy, severe postoperative complications and high perioperative mortality. Vascular variation is another key point in surgical operation, which demands lots of attention and careful management. In physiological state, abdominal blood vessels may vary in different phenotypes, which occasionally cause troubles to surgeons, resulting in increased risk of vascular injuries, perioperative hemorrhage, hepatic or bile duct ischemia and consequent leakage and the like. Based on the previous research and our experience, it is recommended that the vascular variations be treated by specific surgical approaches and techniques in robot-assisted pancreatic surgery.

Common coeliacomesenteric trunk: a computed tomography radiological study.

BACKGROUND: There is an increasing trend for administration of invasive radiological interventions, laparoscopic surgery, and transplantation procedures in recent years, and determining the vascular variations prior to these procedures is crucially important. Coeliacomesenteric trunk (CMT) is among these variations. This study aimed to retrospectively evaluate this rare anomaly by computed tomography (CT). MATERIALS AND METHODS: A total of 1000 CT angiography images were analysed retrospectively, and the patients with mesenteric and coeliac arteries arising from the abdominal aorta with a single root were identified. The level that CMT arose, and its branching patterns were determined individually for all patients. RESULTS: Ten patients (6 males and 4 females) with a mean age of 50.2 years (17-87 years) had CMT in CT images. CONCLUSIONS: The knowledge of variations in the CMT prior to vascular or laparoscopic interventions will contribute to early intervention in case of a complication, or to avoid from a potential damage.