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Fig. 1 | World Journal of Surgical Oncology

Fig. 1

From: Metastasis to para-aortic lymph nodes cephalad to the renal veins in patients with ovarian cancer

Fig. 1

Surgical procedure of Komiyama’s maneuver for extended PAN dissection. First retroperitoneal incision was made along the so-called “Monk’s white line” (a, b). Fusion fascia was incised through the medial side of Gerota’s fascia toward the root of the right renal vein to separate the right kidney from the ascending colon, which was mobilized to expose the region from the anterior surface of the inferior vena cava to the left side of the abdominal aorta (c). Kocher’s maneuver was performed for mobilization of the duodenum (d, e). Second retroperitoneal incision was commenced near the bifurcation of the abdominal aorta into the common iliac arteries and was continued toward the ligament of Treitz, allowing complete mobilization of the small intestine and the right hemicolon (fh). After mobilization, the small intestine and right hemicolon were placed in an isolation bag and lifted out of the abdominal cavity (i). After dissecting the infra-renal PANs, the left and right renal arteries and the left lower adrenal vein were identified, and the supra-renal PANs were dissected (jl)

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