Clinical application of 3D-CT angiography for laparoscopic colorectal surgery

摘要

The purpose of the study was to examine the role of three dimensional helical CT angiography (3D-CTA) as an adjunct to laparoscopic surgery for colonic carcinomas. For the resection of sigmoid and upper rectal carcinomas under laparoscopy, we routinely perform lymph node dissection around root of IMA with preserving the left colic artery. In addition, for right sided colon carcinomas, we perform lymph node dissection exposing so called the surgical trunk (superior mesenteric vein). For either of these procedures performing safely, it is important to know the precise individual vascular anatomy bearing their variations. The 3D-CTA of 25 patients were examined (13: left, 7: right, 5: transverse). These images were compared with intraoperative findings. For left sided cancers, we were able to accurately visualize the left colic artery as well as ascertain its relationship to sigmoidal branches using the 3D-CTA for all patients. For all patients with right sided carcinomas, we were able to assess branches of the superior mesenteric artery as well as determine the presence of right colic artery. These findings were not only confirmed intraoperatively, but knowledge of this anatomy actually facilitated the dissection of these difficult regions.