title: Role of CT angiography with three-dimensional reconstruction of mesenteric vessels in laparoscopic colorectal resections: a randomized controlled trial.
abstract: BACKGROUND
  Laparoscopic surgery, despite its well-known advantages and continuous technological innovations, still has limitations such as the lack of tactile sensation and reduced view of the operative field. These limitations are particularly evident when performing laparoscopic colorectal resection due to the variability of the number and course of mesenteric vessels. Today, the patient's vascular anatomy can be mapped using computed tomography (CT) angiography and processing of the images with rendering software to reconstruct a three-dimensional model of the mesenteric vessels. To assess how prior knowledge of the patient's mesenteric vascular anatomy represents an advantage when performing laparoscopic colorectal resections, we conducted a randomized, parallel, single-blinded controlled trial.
  
  
  METHODS
  From January 2010 to January 2012, all patients with surgical indication to undergo standardized right or left hemicolectomy and anterior rectal resections were randomly assigned to two groups and subjected to CT angiography with three-dimensional reconstruction of mesenteric vessels. In the first group the surgeon was able to view the 3D reconstruction before and during surgery, while in the second group the surgeon was only able to view the 3D reconstruction after surgery.
  
  
  RESULTS
  Evaluation of data from 112 patients shows statistically significantly lower operative time, episodes of difficult identification of right anatomy, and incidence of intraoperative and postoperative complication related to difficult or erroneous identification of mesenteric vessels in the group in which the surgeon was able to view the 3D reconstruction before and during surgery compared with the control group.
  
  
  CONCLUSIONS
  This study shows that prior knowledge of the patient's mesenteric vascular anatomy represents an advantage when performing laparoscopic colorectal resection.
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, School of Medicine and Psychology, Faculty of Medicine and Psychology, St. Andrea Hospital, University Sapienza of Rome, Via di Grottarossa 1035, 00189, Rome, Italy. frasavmari@yahoo.it
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Mari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pancaldi
authors.forename: Carlo Nicola
authors.initials: CN
authors.lastname: De Cecco
authors.forename: Marcello
authors.initials: M
authors.lastname: Gasparrini
authors.forename: Anna
authors.initials: A
authors.lastname: Dall'Oglio
authors.forename: Fioralba
authors.initials: F
authors.lastname: Pindozzi
authors.forename: Andrea
authors.initials: A
authors.lastname: Laghi
authors.forename: Antonio
authors.initials: A
authors.lastname: Brescia
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D003082:Colectomy / Q000379:methods; D003108:Colonic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging*; D008642:Mesenteric Veins / Q000000981:diagnostic imaging*; D061330:Multidetector Computed Tomography / Q000379:methods; D011446:Prospective Studies; D012002:Rectal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D016037:Single-Blind Method