García-Picazo Alberto, Sánchez-Velázquez Patricia, Burdio Fernando, Ielpo Benedetto
Hepato‑Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Pompeu Fabra University, Barcelona, Spain.
Updates Surg. 2025 Jul 1. doi: 10.1007/s13304-025-02307-w.
Anatomical variations of the hepatic artery (HA) are frequent (25-45%), representing a special challenge in minimally invasive surgery. Preoperative knowledge of these variations is essential in pancreaticoduodenectomy (PD) to avoid vascular injury and without compromising mesopancreas resection. Patients with anatomical variants of HA, who underwent PD, were selected including robotic and laparoscopy surgery. In all cases, the "Artery First" approach of the superior mesenteric artery (SMA) was performed allowing the identification of the origin of arterial variants and the gastroduodenal artery to be sectioned. The objective of this multimedia article is to describe the different surgical approaches, including some tips and trick in case of vascular variants.
肝动脉（HA）的解剖变异很常见（25%-45%），这给微创手术带来了特殊挑战。在胰十二指肠切除术（PD）中，术前了解这些变异对于避免血管损伤且不影响中胰切除至关重要。我们选择了接受PD的肝动脉解剖变异患者，包括机器人手术和腹腔镜手术。在所有病例中，均采用肠系膜上动脉（SMA）的“动脉优先”方法，以确定动脉变异的起源并切断胃十二指肠动脉。这篇多媒体文章的目的是描述不同的手术方法，包括血管变异情况下的一些技巧。
