The classification of anatomic variations in the perigastric vessels by dual-phase CT to reduce intraoperative bleeding during laparoscopic gastrectomy.
BACKGROUND
Laparoscopy-assisted distal gastrectomy (LADG) is a less invasive alternative compared with an open procedure. However, it is difficult to obtain a full-view image and to estimate the three-dimensional (3D) relationships between organs during laparoscopic procedures. Determining the vascular anatomy by 3D CT imaging has been shown to play a critical role in reducing the risks associated with laparoscopic gastric cancer surgery. The purpose of this study was to evaluate the clinical anatomic variations and to estimate its positive contribution in obtaining less intraoperative bleeding.


METHODS
Scanning was performed using a 64-row MDCT scanner. Three-dimensional CT images in the arterial and portal phase were reconstructed and fused together using the volume-rendering technique. The intraoperative bleeding findings were compared between two periods.


RESULTS
The anatomic variations of the celiac trunk were divided into six types. There were 159 patients with Adachi's type I, type II=8, type III=1, type IV=1, type V=2, type VI=3, and other=1. The inflows of the left gastric coronary vein (LCV) were divided into three types. The LCV flowed into the portal vein (PV) in 79 patients, into the splenic vein (SpV) in 65, and into the junction of these two veins in 27. The splenic artery was divided into flat type and curved type, and 65 cases (37%) showed the flat type. Intraoperative bleeding was significantly less between 2007 and 2008, in which the operations were performed without first making a 3D anatomy study, than in 2009, in which 3D anatomy studies were made and analyzed before surgery in all patients.


CONCLUSIONS
Dual-phase 3D CT is a useful and essential modality to visualize the precise anatomy around the stomach. As a result, by comparing 3D CT images with our classifications, it is believed that any surgeons may reduce the degree of intraoperative blood loss.
Natsume
Toshiyuki
T
Department of Frontier Surgery, Chiba University Graduate School of Medicine, and Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan. tnatsu22@faculty.chiba-u.jp
Shuto
Kiyohiko
K
Yanagawa
Noriyuki
N
Akai
Takashi
T
Kawahira
Hiroshi
H
Hayashi
Hideki
H
Matsubara
Hisahiro
H
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002445:Celiac Artery / Q000002:abnormalities / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D005743:Gastrectomy; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D008297:Male; D011169:Portal Vein / Q000000981:diagnostic imaging; D013162:Splenic Vein / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D003287:Contrast Media