Journal of Surgical Oncology 50:233 (1992)

THIS IS HOW I DO IT

The Hepatic Artery-A Guide to Major Upper Abdominal Resections

A system; ic wide resection of the stomach or pancreas requires the inclusion of nodes in the lesser omentum and along the hepatic artery-occasionally into the porta he- patis. This dissection is facilitated by early identification

of the common hepatic artery as it travers s the retroperi- toneum. Palpation of the vessel after it leaves the celiac trunk is easily accomplished with upward traction on the liver and downward traction on the stomach. The vessel is skeletonized with sharp scissors dissection and all tis- sue inferior to it is swept down with the specimen. Prior division of the stomach may facilitate the dissection. As the gastric and pancreaticoduodenal branches are di- vided, the vessel springs superiorly to provide a clean dissection of the porta hepatis nodes and exposure of the common bile duct. If the bile duct is to be transsected it can be done at this point enabling the portal vein to be exposed for dissection of any remaining nodes to be re- moved with the specimen.

Bernard Gardner, MD

Department of Surgery University of Medicine and Dentistry

of New Jersey Newark, New Jersey 07103

A aorta L liver S spleen GO greater anentun SW superior mesenteric vein RGA right gastric artery SA splenic artery LGA left gastric artery HA hepatic artery SG short gastric vessels GD gastroduodenal artery

Fig. I . Anatomic details of relationship of hepatic artery in gastric resections. (Reprinted with permission from Gardner B: Extended sub- total gastrectomy for cancer. In Nyhus LM, Baker RJ (eds): “Mastery of Surgery, Second Edition.” Boston: Little, Brown and Company, 1992, p 714.)

0 1992 Wiley-Liss, Inc.

Fig. 2. Dissection of hepatic artery in lesser omentum. (Reprinted with permission from Gardner B: Extended subtotal gastrectomy for cancer. In Nyhus LM, Baker RJ (eds): “Mastery of Surgery, Second Edition.” Boston: Little, Brown and Company, 1992, p 717.)