Laparoscopic D2 lymphadenectomy with preservation of an aberrant left hepatic artery during distal gastric resection for cancer
Epublication WebSurg.com, Jun 2014;14(06). URL: http://websurg.com/doi/vd01en4271
During laparoscopic D2 lymphadenectomy for gastric cancer, an aberrant left hepatic artery (ALHA) can be found arising from the left gastric artery (LGA). It is recommended to preserve this vessel since it is impossible to intraoperatively determine whether it is a “replaced” or “accessory” left hepatic artery. In the present video, we show the technique to preserve the ALHA during a laparoscopic distal gastrectomy performed for a cancer of the antrum in a 78-year-old male patient. A typical D2 laparoscopic lymphadenectomy is performed until the division of the left gastric vein and the identification of the LGA: the ALHA is identified at this time and the anterior side of the LGA is exposed towards its origin; the branch of the LGA towards the stomach is clipped and resected and the lymph nodes located posterior to the ALHA are then dissected completely. Lymphadenectomy is then completed with the dissection of the lymph nodes along the lesser curvature and the right cardiac nodes. Pathological examination revealed a T2N0M0 tumor with 56 lymph nodes examined. The present video demonstrates that preservation of the ALHA is laparoscopically feasible and does not decrease the extent of D2 lymph node dissection.