Anatomical strategies of Henle trunk in laparoscopic right hemi-colectomy for right colon cancer.
- Author:
Bo FENG
1
,
2
;
Xialin YAN
;
Sen ZHANG
;
Pei XUE
;
Zirui HE
;
Minhua ZHENG
Author Information
1. Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine
2. Shanghai Minimally Invasive Surgery Clinical Medical Center, Shanghai 200025, China. fengbo2022@163.com.
- Publication Type:Journal Article
- From:
Chinese Journal of Gastrointestinal Surgery
2017;20(6):635-638
- CountryChina
- Language:Chinese
-
Abstract:
The advancement of laparoscopic surgery serves as a trigger for better understanding of the vascular structure at the inferior border of the pancreas, especially Henle trunk. Henle trunk was first found as convergence to superior mesenteric vein (SMV) conjoined by sub-right colon vein (SRCV) and right gastroepiploic vein (RGEV), but decades later, anterior superior pancreatic duodenal vein (ASPDV) was described as another conjoint vein of Henle trunk. These tributaries are the basic elements of Henle trunk in early years' study. A proper surgical procedure for Henle trunk can significantly reduce the complications of radical right hemi-colectomy (Japanese D3 resection and European complete mesocolic excision, CME). There are four variations of Henle trunk according to the colic venous tributaries that consists the anatomic variations in transverse colon posterior space(TRCPS). These variations are like "fingerprint and pattern" of CME. The recognition and extension of the TRCS is the key to the dissection of Henle trunk in laparoscopic right hemi-colectomy. Our medical center proposed four feasible approaches for extension:(1) hybrid medial approach; (2) completely medial approach; (3)completely medial access by "page-turning" approach; (4) completely medial approach along RCV. Mostly, RCV ended in Henle trunk, and completely medial approach along RCV is efficient to identify the Henle trunk in CME. We suggest dissecting the inferior margin of pancreas along SMV in a bottom-to-top fashion, followed by the dissection of middle colic vessels to reveal the root of Henle trunk. And it's better to dissect Henle trunk by branch rather than at its root for safety. Here, we describe the anatomic characters of Henles trunk, the surgical approach and strategies of Henle trunk in laparoscopic surgery.
