Laparoscopic lymph node dissection around the inferior mesenteric artery with preservation of the left colic artery.
OBJECTIVE
Curative resection of sigmoid and rectal cancer includes "high tie" of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the leakage rate. Accordingly, some surgeons employ a technique of lymph node (LN) dissection around the IMA, preserving the IMA and left colic artery (LCA). The same technique was reported to need longer time in laparoscopic surgery due to technical difficulties. We present herein a simple and secure method of laparoscopic LN dissection around the IMA that allows preservation of the IMA and LCA, and report the operative results.


METHODS
Our method involves peeling off the vascular sheath from the IMA and dissection of the LN around the IMA together with the sheath. The feasibility of the technique was evaluated in 72 consecutive cases of laparoscopic resection of sigmoid and rectal cancer.


RESULTS
The IMA was ligated at its root in 27 cases (high tie, group A). Lymph nodes around the IMA were dissected with preservation of the IMA and LCA in 21 cases (group B). The root of the superior rectal artery was ligated in 24 cases of Tis and T1N0 ("low tie," group C). Mean operative time was 207.6, 221.2, and 198.5 min for group A, B, and C, respectively. Respective blood loss was 47.8, 44.0, and 58.5 g, and mean numbers of harvested LN were 17.3, 16.3, and 10.7. None of the operative results of groups A and B were different statistically. LN dissection was not associated with any morbidity.


CONCLUSIONS
Our method allows equivalent laparoscopic lymph node dissection to the high tie technique without excessive operative time or bleeding.
Sekimoto
Mitsugu
M
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, 565-0871, Japan. msekimoto@gesurg.med.osaka-u.ac.jp
Takemasa
Ichiro
I
Mizushima
Tsunekazu
T
Ikeda
Masataka
M
Yamamoto
Hirofumi
H
Doki
Yuichiro
Y
Mori
Masaki
M
D000368:Aged; D057868:Anastomotic Leak / Q000517:prevention & control; D001158:Arteries; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003106:Colon / Q000098:blood supply; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008026:Ligation / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery; D012811:Sigmoid Neoplasms / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome