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Importance of the Moskowitz artery in the laparoscopic medial approach to splenic flexure mobilization: a cadaveric study

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Abstract

Background

The medial approach in laparoscopic splenic flexure mobilization is based on the entrance to the lesser sac just above the ventral edge of the pancreas (VEOP). The artery of Moskowitz runs through the base of the mesocolon, just above the VEOP. The aim of this study was to assess the incidence of the artery of Moskowitz, its route and its distance from the VEOP.

Methods

We performed a cadaveric study on 27 human cadavers. The vascular arcades of the splenic flexure were dissected, the number of vascular arches, and the origin and localization of its terminal anastomosis were recorded. The splenic flexure avascular space (SFAS) was defined as the avascular zone in the mesocolon delimited by the VEOP, middle colic artery, ascending branch of the left colic artery and the vascular arch of the splenic flexure nearest to the VEOP and was quantified as the distance between the VEOP and the most proximal arch

Results

The artery of Drummond was identified in 100% of the cadavers. In 5 of 27 (18%) Riolan’s arch was present, and in 3 of 27 (11%) the Moskowitz artery was found. The mean distance from the VEOP to the artery of Moskowitz was 0.3 cm (SD 0.04). This vascular arch travelled from the origin of the middle colic artery to the distal third of the ascending branch of the left colic artery. The SFAS was greater (p = 0.001) in cadavers that only presented the artery of Drummond (mean 6.8 cm; SD 1.25) than in those with Riolan’s arch (mean 4.5 cm; SD 0.5)

Conclusions

In the medial approach for laparoscopic mobilization of the splenic flexure, when only one of the arches is present, the avascular area is an extensive and secure territory. If the artery of Moskowitz is present, the area is nonexistent and this would contraindicate the approach due to risk of iatrogenic bleeding. A radiological preoperatory study could be essential for accurate and safe surgery in this area.

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Author information

Authors and Affiliations

  1. Colorectal Surgery Unit, Hospital Universitario y Politecnico la Fe, Valencia, Spain

    A. Garcia-Granero, L. Sánchez-Guillén, O. Carreño, J. Sancho Muriel, E. Alvarez Sarrado, B. Flor Lorente, M. Frasson & E. Garcia-Granero

  2. Cardiovascular Surgery Department, Hospital Clinico Universitario, Valencia, Spain

    D. Fletcher Sanfeliu

  3. Surgical Anatomy Unit, Anatomy and Embryology Department, Valencia University, Valencia, Spain

    F. Martinez Soriano

Authors
  1. A. Garcia-Granero
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  2. L. Sánchez-Guillén
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  3. O. Carreño
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  4. J. Sancho Muriel
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  5. E. Alvarez Sarrado
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  6. D. Fletcher Sanfeliu
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  7. B. Flor Lorente
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  8. M. Frasson
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  9. F. Martinez Soriano
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  10. E. Garcia-Granero
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Contributions

Alvaro Garcia-Granero and Luis Sánchez-Guillén were involved in conception and design. Omar Carreño, Jorge Sancho Muriel, Eduardo Alvarez Serrado and Delfina Fletcher Sanfeliu were involved in design and acquisition. Blas Flor Lorente, Matteo Frasson, Francisco Martinez Soriano and Eduardo Garcia-Granero revised the work critically.

Corresponding author

Correspondence to A. Garcia-Granero.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval and informed consent

The cadaver specimens were obtained through strict body donation legislation and regulations, subject to Spanish national law.

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Garcia-Granero, A., Sánchez-Guillén, L., Carreño, O. et al. Importance of the Moskowitz artery in the laparoscopic medial approach to splenic flexure mobilization: a cadaveric study. Tech Coloproctol 21, 567–572 (2017). https://doi.org/10.1007/s10151-017-1663-3

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  • DOI: https://doi.org/10.1007/s10151-017-1663-3

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