Comparison of retrocarotid and caudocranial dissection techniques for the surgical treatment of carotid body tumors Carlos A. Hinojosa, MD, MS, Laura.

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Comparison of retrocarotid and caudocranial dissection techniques for the surgical treatment of carotid body tumors Carlos A. Hinojosa, MD, MS, Laura J. Ortiz-Lopez, MD, Javier E. Anaya-Ayala, MD, Vicente Orozco-Sevilla, MD, Ana E. Nunez-Salgado, MD Journal of Vascular Surgery Volume 62, Issue 4, Pages 958-964 (October 2015) DOI: 10.1016/j.jvs.2015.05.001 Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 1 A, The patient's head is turned away from the surgical site and a cervical incision centered over the carotid bifurcation and parallel and anterior to the sternocleidomastoid muscle is made. The incision is carried through the platysma and down to the carotid sheath. B, The sternocleidomastoid muscle and the jugular vein are pulled laterally. The patient's position, incision, approach to the carotid sheath, control of the common carotid artery (CCA), identification of the hypoglossal nerve, and ligation of the facial vein are carried in the same way in both the standard caudocranial dissection (SCCD) and retrocarotid dissection (RCD) techniques. Journal of Vascular Surgery 2015 62, 958-964DOI: (10.1016/j.jvs.2015.05.001) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 2 Standard caudocranial dissection (SCCD) technique for complete resection of a right carotid body tumor (CBT). Upon recognition of the tendon of the digastric muscle, the hypoglossal nerve is identified and encircled with a vessel loop. Subadventitial dissection of the CBT is carried upwards in caudocranial direction anterior to the vessels from the bifurcation until total resection is achieved. ICA, Internal carotid artery. Journal of Vascular Surgery 2015 62, 958-964DOI: (10.1016/j.jvs.2015.05.001) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 3 Intraoperative photograph demonstrates the retrocarotid dissection (RCD) technique for a right carotid body tumor (CBT) resection. A, Dissection of the CBT starts below the bifurcation with the use of bipolar cautery control feeding vessels. B, Subsequently the CBT is released from the bifurcation. CCA, Common carotid artery; ICA, internal carotid artery. Journal of Vascular Surgery 2015 62, 958-964DOI: (10.1016/j.jvs.2015.05.001) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 4 Retrocarotid dissection (RCD) technique. A, Once the carotid body tumor (CBT) is released from the bifurcation, the external carotid artery (ECA) is gently rotated laterally in the direction of the hollow white arrow. B, The surgeon pulls the CBT from behind the ECA, achieving posterior luxation of the proximal end. Journal of Vascular Surgery 2015 62, 958-964DOI: (10.1016/j.jvs.2015.05.001) Copyright © 2015 Society for Vascular Surgery Terms and Conditions

Fig 5 Retrocarotid dissection (RCD) technique. A, The posterior luxation allows better visualization of the subadventitial plane of Gordon and Taylor, therefore making the dissection faster and reducing the risk of vascular injury. B, The resection is completed with the use of bipolar cautery and Metzenbaum scissors, with minimal blood loss. Further details are shown in the Supplementary Video (online only). Journal of Vascular Surgery 2015 62, 958-964DOI: (10.1016/j.jvs.2015.05.001) Copyright © 2015 Society for Vascular Surgery Terms and Conditions