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Hayashi H, Hirahara N, Matsubara T, Takao S, Okamura H, Nakamura K, Kishi T, Taniura T, Zotani H, Ishitobi K, Tajima Y. Duplicate left gastric artery identified during robot-assisted distal gastrectomy: a case report. Surg Case Rep 2023; 9:148. [PMID: 37610522 PMCID: PMC10447737 DOI: 10.1186/s40792-023-01698-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/13/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Duplicated left gastric artery (LGA) is a rare anomaly. With an incidence of only 0.4%, its clinical significance remains largely unrecognized. CASE PRESENTATION A 65-year-old man underwent robot-assisted distal gastrectomy for early gastric cancer. After division of the left gastric vein in the left gastropancreatic fold, a slim LGA (LGA-1) was identified and dissected. Careful dissection of the left gastropancreatic fold toward the root of the celiac artery revealed another LGA (LGA-2), which was dissected without difficulty. Postoperative reevaluation of the three-dimensional-computed tomography (CT) angiography reconstructed using the preoperative CT scan identified a 2.7 mm LGA-1, branching from the splenic artery, and a 3.0 mm LGA-2, branching from the celiac artery. To the best of our knowledge, this is only the third reported case of a duplicate LGA in a patient who underwent laparoscopic gastrectomy. Our case is the first to report the use of robot surgery. CONCLUSIONS Although duplicate LGA is rare and receives little clinical attention, surgeons should keep this vascular anomaly in mind during preoperative evaluation since there is an increased risk for intraoperative bleeding during gastrectomy.
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Affiliation(s)
- Hikota Hayashi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Takeshi Matsubara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Satoshi Takao
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Hiroki Okamura
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Kosuke Nakamura
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Takashi Kishi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Takahito Taniura
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Hitomi Zotani
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane 693-8501 Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, 89-1, Enya-Cho, Izumo, Shimane 693-8501 Japan
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Ito S, Ogawa R, Saito M, Ueno S, Hayakawa S, Okubo T, Sagawa H, Tanaka T, Takahashi H, Matsuo Y, Takiguchi S. Laparoscopic gastrectomy for gastric cancer with two left gastric arteries: Safe and adequate lymphadenectomy in a rare arterial abnormality. Asian J Endosc Surg 2023; 16:105-109. [PMID: 35859348 DOI: 10.1111/ases.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/23/2022] [Accepted: 07/02/2022] [Indexed: 01/05/2023]
Abstract
Clinical studies have established the safety and advantages of laparoscopic surgery for gastric cancer; therefore, laparoscopic gastrectomy (LG) in clinical practice is increasing. We report the case of a 77-year-old patient with gastric cancer who was referred to our center for LG. Esophagogastroduodenoscopy revealed a type 3 tumor identified as adenocarcinoma on biopsy. Three-dimensional computed tomography-angiography revealed two left gastric arteries (LGAs) branching from the celiac trunk. By laparoscopically performing the outermost layer-oriented lymphadenectomy (OML-OL), the two LGAs were detected and appropriately divided. Subtotal gastrectomy was completed, and the patient had an uneventful postoperative course. The OML-OL was appropriate for LG in this situation. This case demonstrates the necessity of preoperative three-dimensional computed tomography-angiography with 1-mm slices and the importance of performing OML-OL.
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Affiliation(s)
- Sunao Ito
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryo Ogawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masaki Saito
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuhei Ueno
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shunsuke Hayakawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tomotaka Okubo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Sagawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tatsuya Tanaka
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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