title: [Inventive Approach during Laparoscopic Distal Gastrectomy for Treatment of Gastric Cancer in Patients with Adachi Type Ⅵ Vascular Anomaly].
abstract: Vascular anomalies, as described by the Adachi classification, are an inevitable issue for gastric cancer surgery. Here, we report a safe technique for laparoscopic lymph node dissection in a patient with Adachi typeⅥ vascular anomaly. The patient is a 72-year-old woman, who presented with a submucosal gastric cancer located on the lesser curvature of the stomach. Preoperative MDCT revealed Adachi type Ⅵ vascular anomaly. At laparoscopic surgery, we first identified the portal vein. Then, dissection of the hepatoduodenal and No. 8a lymph nodes was performed from the location near the portal vein at the superior portion of the hepatoduodenal ligament to that near the splenic vein superior to the pancreas. This avoids the disorientation that may result from anomalous vessels and prevents error that can lead to vascular complications. Subsequently, she underwent D1 plus gastrectomy. Her postoperative course was uneventful. Our surgical technique offers a safe approach for laparoscopic gastrectomy in the patient with Adachi type Ⅵ vascular anomaly.
authors.affiliation: Division of Digestive Surgery, Dept. of Surgery, Kyoto Prefectural University of Medicine.
authors.forename: Toru
authors.initials: T
authors.lastname: Mizutani
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.forename: Mahito
authors.initials: M
authors.lastname: Miyamae
authors.forename: Shoji
authors.initials: S
authors.lastname: Hirajima
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kosuga
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.forename: Hisashi
authors.initials: H
authors.lastname: Ikoma
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000368:Aged; D000792:Angiography; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy / Q000379:methods*; D009389:Neovascularization, Pathologic / Q000601:surgery*; D013274:Stomach Neoplasms / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*