Preoperative simulation of vascular anatomy by three-dimensional computed tomography imaging in laparoscopic gastric cancer surgery.
BACKGROUND
Treatment of early gastric cancer may be an ideal application for laparoscopic surgery. But laparoscopic surgery has various limitations derived from the lack of tactile feedback and a two-dimensional display of the operative field. So, laparoscopic surgery is technically challenging and requires a more detailed understanding of local anatomy than conventional open surgery does. The purpose of this study was to evaluate the value of three-dimensional computed tomography imaging in the preoperative simulation of laparoscopic gastric cancer surgery.


METHODS
Multidetector-row helical CT was performed preoperatively in 49 patients who underwent laparoscopic gastric cancer surgery. Scanning was initiated approximately 20 seconds after an intravenous injection of 100 mL of contrast material at 5 mL/second. Three-dimensional CT images were reconstructed using the volume-rendering technique.


RESULTS
3D-CT imaging depicted the stomach, arterial, and venous anatomy and was able to identify important vascular variants. Preoperative information concerning the right gastric artery led us to the site of its branching and facilitated dissection of suprapyloric lymph nodes. The left gastric artery furnishing the aberrant left hepatic artery was successfully revealed and this information enabled us to avoid accidental hemorrhage and ischemic liver damage. Preoperative confirmation of the drainage routes of the left gastric vein was also useful in accomplishing secure lymphadenectomy.


CONCLUSIONS
3D-CT imaging provides a vascular "road map," which is critical for surgical guidance, and prevents the risks involved in surgery. Preoperative 3D-CT imaging may be an informative device to overcome the disadvantages of laparoscopic gastric cancer surgery.
Lee
Sang-Woong
SW
General and Gastroenterological Surgery, Osaka Medical College, Takatsuki City, Osaka, Japan.
Shinohara
Hisashi
H
Matsuki
Mitsuru
M
Okuda
Junji
J
Nomura
Eiji
E
Mabuchi
Hideaki
H
Nishiguchi
Kanji
K
Takaori
Kyoichi
K
Narabayashi
Isamu
I
Tanigawa
Nobuhiko
N
D003198:Computer Simulation; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D015203:Reproducibility of Results; D013274:Stomach Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed