Minimally invasive approach to safe pedicle dissection in rectal cancer surgery—A video vignette

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2025-02-25 DOI:10.1111/codi.70049

Akash Mor, Chintan Safi, Ankit Sharma, Avanish Saklani

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引用次数: 0

Abstract

This video (Video 1) addresses critical considerations for safe pedicle dissection in rectal cancer surgery, focusing on three key challenges: the meandering artery of Moskowitz, high versus low ligation of the inferior mesenteric artery (IMA) and atypical D3/D4 nodes of unknown significance. The meandering artery of Moskowitz, a vascular connection between the superior and inferior mesenteric arteries, is distinguished from the arc of Riolan by its more prominent and consistent collateral circulation [1]. Proper identification and management of this artery during surgery are crucial to prevent ischaemic complications, such as gangrene of the colon. Additionally, the video discusses the outcomes of high versus low IMA ligation, highlighting the preference for low ligation in elderly or atherosclerotic patients to reduce nerve damage and preserve blood flow [2]. Lastly, we introduce ‘Bansod nodes’, atypical nodes located between the superior hypogastric plexus and the IMA, which cannot be classified as D3 or D4 nodes. Although typically benign, these nodes should be removed during surgery due to occasional malignancy. This video provides strategies for safe pedicle dissection, and offers essential insights to improve oncological outcomes and minimize surgical risks.

Akash Mor: Conceptualization; visualization; writing – review and editing. Chintan Safi: Writing – original draft. Ankit Sharma: Writing – original draft; writing – review and editing. Avanish Saklani: Conceptualization; methodology; supervision.

None.

None declared.

None, there were no human subjects.

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.