Abstract
A 60-year-old woman was referred to our department of surgery for further examination of early gastric cancer. Preoperative Multidetector-row computed tomography (MDCT) showed a vascular anomaly of Type VI in Adachi's classification ; in which the common hepatic artery (CHA) arising from the superior mesenteric artery (SMA) runs behind the portal vein (PV). In Adachi type VI, CHA cannot be detected at the superior border of the pancreas. Since it was diagnosed as Adachi type VI by preoperative MDCT, laparoscopic-assisted distal gastrectomy with D1+β dissection was performed safely without damaging the portal system by exposing the anterior side of the portal vein. The left gastric vein was identified while keeping this layer in the No.8a lymph node dissection. In laparoscopic surgery, the running pattern of the vessel cannot be confirmed by manual palpation during the operation. Consequently it is important to understand the vessel running pattern prior to laparoscopic surgery by using MDCT.
