Mesenteric-guided approach to pyloric lymphadenectomy in laparoscopic radical gastrectomy

Figure 1 Schematic illustrations of the right gastroepiploic mesentery: Anatomical components, separation, and dissection. A: Schematic diagram of the three key anatomical components of the right gastroepiploic mesentery; B: Schematic diagram showing the complete separation of the right gastroepiploic mesentery from the transverse mesocolon and identification of the three suspension points of the right gastroepiploic mesentery “anterior” surface; C: Schematic diagram showing the exposure and division of the connection of the right gastroepiploic mesentery; D: Schematic diagram showing the exposure and division of the right gastroepiploic mesentery “posterior” surface. ASPDV: Anterior superior pancreaticoduodenal vein; GDA: Gastroduodenal artery; RGEV: Right gastroepiploic vein; RGEA: Right gastroepiploic arteria; CME: Complete mesogastric excision; CVL: Central vascular ligation; A: Anterior; P: Posterior; A1: First suspended point; A2: Second suspended point; A3: Third suspended point.

Figure 2 Surgical quality control of D2 Lymphadenectomy plus complete mesogastric excision. A: Exposure of the right omental mesentery “anterior (A)” surface with a triangular suspension line (white dashed) as the standardized dissection landmark; B: Division of the right gastroepiploic vein at a specified distance from point A1, demonstrating vascular skeletonization technique; C: Right lateral wall of the duodenal bulb defining the lower margin of the “posterior (P)” surface; D: Right side of the gastroduodenal artery marking the left border of the “P” surface; E: Cleaned “A” surface showing intact mesenteric vasculature after dissection; F: Post-excision specimen with dual-plane suspension lines (A/P surfaces) verifying resection margins; G: Excised right omental mesentery specimen maintaining original anatomical morphology. ASPDV: Anterior superior pancreaticoduodenal vein; RGEV: Right gastroepiploic vein; RGEA: Right gastroepiploic arteria; IPA: Inferior pylorus artery; A: Anterior; P: Posterior; A1: First suspended point; A2: Second suspended point; A3: Third suspended point.