PONE-D-23-27540Novel embryological classifications of hepatic arteries based on the relationship between aberrant right hepatic arteries and the middle hepatic artery: a retrospective study of contrast-enhanced computed tomography imagesPLOS ONE

Dear Dr. Uraoka,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Reviewers provided several important questions.

Please respond to these questions, or if you are unable to respond, please address these issues in the discussion section. In particular, I think it would be better to describe the clinical impact of this study more clearly.

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We look forward to receiving your revised manuscript.

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Yoshihisa Tsuji

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have examined the anatomical patterns of hepatic arteries and have identified that MHA can branch from aRHA only when CHA branches from SMA (Type 4). However, there is a lack of logical consistency, and the clinical significance of their findings remains unclear.

<major issues="">

1. I think that an injury to the aRHA can result in severe liver ischemia, regardless of the origin of the MHA. Additionally, while the authors described “little is known about whether the MHA branches from aRHAs”, they also mentioned that such anomaly can be a cause of severe liver ischemia due to intraoperative injury. They should clarify what is unknown and why they are investigating this topic.

2. There is no explanation provided as to why the authors classified the anatomical patterns of hepatic arteries based on the presence or absence of rLHA, not only the RHA and MHA patterns. They should specify why the information about rLHA was necessary for this study?

3. The most significant finding of this study is that the authors found MHA branching from aRHA only in Type 4b. However, whether MHA branches from RHA or LHA in Type 4 appears to have little impact on the risk of severe liver ischemia during PD. I believe that recognizing Type 1a and Type 3 is more important for avoiding intraoperative injury to MHA.

4. Much of the information in the discussion section repeats what was described in the introduction section. The authors should provide a more concise discussion of what they have learned from this study, how it differs from previous reports, and how their findings can be applied to improve clinical practice.

5. Their conclusion that "preoperative recognition and intraoperative assessment of aRHA flow is essential to avoid injury" cannot be supported by their findings.</major>

Reviewer #2: “Novel embryological classifications of hepatic arteries based on the relationship between aberrant right hepatic arteries and the middle hepatic artery: a retrospective study of contrast-enhanced computed tomography images” by Urakawa et al. describes the classification of hepatic arteries based on the data of the origin of RHAs and MHA courses. It is a important clinical concern, and the manuscript is well written. However, there are some issues to be addressed as following;

Major

1 This is only a classification, and the clinical utility should be demonstrated. As there have been several classifications of hepatic arteries previously, authors should compare them and their own classifications in the point of view of clinical importance, and demonstrate the superiority of their classification.

2 They describe the frequencies of each variant of hepatic arteries, however, these are not validated elsewhere, especially, several rare variants described here.　

3 They conclude that preoperative recognition and intraoperative assessment of aRHA flow is essential to avoid injury. There is no data in this manuscript supporting this conclusion. It is important that surgery-associated injury can be significantly reduced when their novel classification is recognized by surgeons. If they have experienced any cases in which unexpected injury occurred during hepatobiliary-pancreatic surgery without the knowledge of the novel classifications of hepatic arteries, they might be helpful for demonstrating the necessity of their novel classification.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-23-27540R1Novel embryological classifications of hepatic arteries based on the relationship between aberrant right hepatic arteries and the middle hepatic artery: a retrospective study of contrast-enhanced computed tomography imagesPLOS ONE

Dear Dr. Uraoka,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Mar 14 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Yoshihisa Tsuji

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

As results of assessment by several reviewers, the content seems to be improved compared to the previous version. Please respond to a few more comments from additional reviewers.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

Reviewer #4: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

Reviewer #4: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

Reviewer #4: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

Reviewer #4: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: They found branching of the middle hepatic artery from aberrant hepatic artery (aRHA) is very rare. Authors responded to the reviewers’ comment properly. This is useful for surgeons.

Reviewer #4: Uraoka et al. retrospectively reported the relationship between aRHAs and the MHA based on the embryological development of visceral arteries in 759 patients at a single institution. Two board-certified surgeons, but not radiologists, reviewed 3D and CT images of the arterial phase, and clarified the branching type of MHA. Subsequently, they concluded that branching of the MHA from aRHAs was considered rare, and however, preoperative recognition and intraoperative assessment of aRHA flow was essential to avoid injury.

The first revise process made this manuscript better.

There are a few comments to be addressed.

1. In conclusion, the authors described that branching of the MHA from aRHA was considered rare. Actual proportion of the MHA from aRHA is coincident with incidence of type 4 (2.1%)? Please clarify this proportion in the results of abstract and text.

2. There were too many abbreviations in the text. Unfamiliar abbreviation should not be used such as HMT.

3. Abbreviation in figure title should not be also used.

I appreciate for giving me an opportunity to review this manuscript.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

Reviewer #4: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Novel embryological classifications of hepatic arteries based on the relationship between aberrant right hepatic arteries and the middle hepatic artery: a retrospective study of contrast-enhanced computed tomography images

PONE-D-23-27540R2

Dear Dr. Uraoka,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Yoshihisa Tsuji

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: