title: Three-dimensional reconstruction of vascular arrangement including the hepatic artery and left gastric vein during gastric surgery.
abstract: BACKGROUND
  During gastric surgery, precise recognition of the anatomical variations and relationships among gastric tumors and vessels, including the hepatic artery (HA) and left gastric vein (LGV), is required. We utilized a three-dimensional (3D) reconstructed image as a preoperative simulation for gastric surgery.
  
  
  METHODS
  We retrospectively analyzed 84 patients who underwent gastrectomy at Tsukuba Medical Center Hospital. This cohort was sequentially divided into a without-3D group (n = 42) and with-3D group (n = 42), and the perioperative outcomes were compared. The 3D image could be used to classify the HA or LGV arrangement pattern.
  
  
  RESULTS
  Regarding the HA arrangement, the right HA of 1 patient (2.3 %) was arising from the superior mesenteric artery, the left HA of 8 patients (19 %) was arising from the left gastric artery, 29 patients (69 %) presented a normal rearrangement, and 4 patients (9.5 %) exhibited other arrangements. The analysis of the LGV arrangement revealed that the LGV in 15 patients (36 %) was located on the dorsal side of the common HA, the LGV in 5 patients (12 %) was located on the ventral side of the common HA, the LGV in 12 patients (29 %) was found on the ventral side of the splenic artery, the LGV in 6 patients (14 %) was located on the dorsal side of the splenic artery, and 4 patients (9.5 %) presented other arrangements. The intraoperative blood loss in the without-3D and with-3D groups was 276 ± 430 and 157 ± 170 g, respectively (p = 0.027).
  
  
  CONCLUSIONS
  The 3D reconstruction technique was useful for understanding and sharing anatomic information during gastric surgery.
authors.affiliation: Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558 Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Miyamoto
authors.affiliation: Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558 Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Inagawa
authors.affiliation: Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558 Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Nagai
authors.affiliation: Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558 Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Maeda
authors.affiliation: Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558 Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kemmochi
authors.affiliation: Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki 305-8558 Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Yamamoto
keywords: Gastric surgery; Hepatic artery; Laparoscopy-assisted distal gastrectomy; Left gastric vein; Three-dimensional reconstruction