ArticleTechniques in coloproctology2017
Importance of the Moskowitz artery in the laparoscopic medial approach to splenic flexure mobilization: a cadaveric study.
Article in Techniques in coloproctology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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16 citing papers in PubMed, 36 citations in OpenAlex.
- Thin Membranous Connective Tissue Encasing the Superior Mesenteric Vessels as an Objective Landmark for Robotic D3 Lymphadenectomy in Right-sided Colon Cancer: A Histological Study and Intraoperative Video Review.Journal of the anus, rectum and colon · 2026Article
- Innovative pancreas-guided technique for splenic flexure mobilization in laparoscopic left hemicolectomy.Surgical endoscopy · 2024Article
- The value of treatment choice and clinical prognosis for Riolan's arch in chronic superior mesenteric artery ischaemic disease.International journal of colorectal disease · 2024Article
- Unveiling the hidden: identification and management of overlooked blood vessels in laparoscopic left hemicolectomy for splenic flexure cancer.BMC surgery · 2024Article
- Neglected Anatomical Areas in Ovarian Cancer: Significance for Optimal Debulking Surgery.Cancers · 2024Review
- Cadaveric and CT angiography study of vessels around the transverse colon mesentery.World journal of surgical oncology · 2023Article
- 3D mesenteric angiogram-based assessment of Arc of Riolan crossing the inferior mesenteric vein: important considerations in high ligation during splenic flexure takedown in anterior resection.Surgical and radiologic anatomy : SRA · 2022Article
- Anatomical variations of the branches from left colic artery and middle colic artery at splenic flexure.Surgical and radiologic anatomy : SRA · 2022Article
- The importance of the Moskowitz artery as a lesser-known collateral pathway in the medial laparoscopic approach to splenic flexure mobilisation and its evaluation with preoperative computed tomography.Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques · 2021Article
- Extended right colectomy, left colectomy, or segmental left colectomy for splenic flexure carcinomas: a European multicenter propensity score matching analysis.Surgical endoscopy · 2021Article
- A video guide of five access methods to the splenic flexure: the concept of the splenic flexure box.Surgical endoscopy · 2020Article
- The laparoscopic medial-to-lateral approach to the splenic flexure.Techniques in coloproctology · 2019Article
- Cranial-first approach for laparoscopic surgery with splenic flexure mobilization.Techniques in coloproctology · 2019Article
- Standardize the Surgical Technique and Clarify the Relevant Anatomic Concept for Complete Mobilization of Colonic Splenic Flexure Using da Vinci XiWorld journal of surgery · 2019Article
- Application of three-dimensional printing in laparoscopic dissection to facilitate D3-lymphadenectomy for right colon cancer.Techniques in coloproctology · 2018Article
- Inferior pancreatic approach for laparoscopic splenic flexure mobilization.Techniques in coloproctology · 2018Article
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 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.
methodsWe 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
resultsThe 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)
conclusionsIn 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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