title: Totally replaced right hepatic artery in pancreaticoduodenectomy: is this anatomical condition a contraindication to minimally invasive surgery?
abstract: The appropriate approach, in the case of an aberrant right hepatic artery (RHA) during open pancreaticoduodenectomy (PD), has already been established. The aim of our study is to analyze the short-term surgical and oncological outcomes after robotic PD in patients with anatomical variants, with a special focus on totally replaced RHA.
  
  
  
  This study is a retrospective review of a prospectively maintained database collected from consecutive patients who underwent robotic PD at the University of Illinois Hospital and Health Sciences System between September 2007 and April 2015.
  
  
  
  Fifteen patients (20.5%) presented with an anatomical variation of the RHA. Four patients had an accessory RHA and 11 had a totally replaced RHA. 50% of the cases were recognized by the radiologist preoperatively. There were no significant differences in the pre- and postoperative outcomes of the aberrant and normal RHA group. The mean number of harvested lymph nodes in the totally replaced RHA group was 22.8 ± 11.4. The rate of positive resection margins was 0% in the totally replaced RHA group and 9% in the normal RHA group.
  
  
  
  This study suggests that robotic PD has no negative impact on surgical and oncological outcomes in patients with a totally replaced RHA.
authors.affiliation: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA; Division of Pancreatobiliary Surgery, Department of Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea.
authors.forename: Ji Hun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
authors.forename: Raquel
authors.initials: R
authors.lastname: Gonzalez-Heredia
authors.affiliation: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
authors.forename: Despoina
authors.initials: D
authors.lastname: Daskalaki
authors.affiliation: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Rashdan
authors.affiliation: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Masrur
authors.affiliation: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA. Electronic address: piercg@uic.edu.
authors.forename: Pier C
authors.initials: PC
authors.lastname: Giulianotti
mesh_terms: D000368:Aged; D002641:Chicago; D016208:Databases, Factual; D005260:Female; D006499:Hepatic Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome