| Part one Anatomical study of the inferior mesenteric artery in laparoscopic surgery and three-dimensional CT vascular angiographyObjectives: To analyze the anatomical relationship of the inferior mesenteric artery(IMA)and its branches by reviewing the laparoscopic left-sided colorectal cancer surgery video and comparing it with the preoperative three-dimensional computed tomography(3D-CT)angiography,and verify the accuracy of 3D-CT vascular reconstruction techniques.Methods: The high-definition surgical video and preoperative imaging data of 135 patients with laparoscopic left-sided colorectal cancer surgery were analyzed,and the alignment pattern between the IMA and its branches and the inferior mesenteric vein(IMV)was observed and summarized.The above two methods were used to measure the length of IMA and its branches.Results: Among the 135 patients,51.1% of patients’ sigmoid artery(SA)co-trunked with the superior rectal artery(SRA),and 28.9% of patients’ left colic artery(LCA)co-trunked with the SA.In 2.9% of patients,SA was co-trunked with both LCA and SRA,LCA,SA,and SRA emanated from the same point in 14.2% of patients,and LCA was absent in 2.9% of patients.The range of D cm(IMA length measured by intraoperative silk thread)and d cm(IMA length measured by 3D-CT vascular reconstruction)in all cases was 1.84cm-6.62 cm and 1.85cm-6.52 cm,and there was a statistical difference between them(P=0.002).In the positional relationship between LCA and IMV,both preoperative CT images and intraoperative observations were consistent.The lengths between the intersection of LCA and IMV measured intraoperatively were 2.20cm-4.02 cm,2.85cm-4.28 c,2.69cm-3.69 cm and 2.11cm-4.01 cm in types 1A,1B,1C,and 2,respectively,there was no significant difference between the groups(P=0.853).Part two Anatomical study of the superior mesenteric artery in laparoscopic surgery and three-dimensional CT vascular angiographyObjective: The anatomical relationships and differences between the main trunk and its branches of the superior mesenteric vessels were explored by comparing preoperative CT three-dimensional angiography with the surgical video of laparoscopic right hemicolectomy for colon cancer.Methods: High-definition surgical videos and preoperative imaging data of 52 patients undergoing laparoscopic right hemicolectomy for colon cancer were analyzed to observe and summarize the probability of occurrence and adjacency of ileocolic vessels,right colic vessels,and middle colic vessels;the length of specific sites of superior mesenteric artery(SMA)branches was also measured using the above two methods.Results: Preoperative CT images and surgical video showed that the ileocolic artery(ICA)was present in 98.1%(51/52)and the ileocolic vein(ICV)was present in 100%(52/52),and ICA was present in 13.7%(7/51)of ICV directly anteriorly,13.7%(7/51)anteriorly superiorly,3.9%(2/51)anteriorly inferiorly,11.8%(6/51)directly posteriorly,post superiorly was37.2%(19/51)and posteriorly inferiorly was 19.7%(10/51).In the surgical video,the probability of the right colic artery(RCA)being present was21.2%(11/52).One RCA was present in 10 patients(90.9%)and two RCAs were present in one patient(9.1%).On CT images,RCA was present in 10 patients.the length of the origin of the middle colic artery(MCA)from its bifurcations was 2.33 ± 0.87 cm(0.00 to 3.90 cm)measured intraoperatively using a sterile isometric filament,and the length measured by 3D-CT vascular reconstruction was 2.36±0.91 cm(0.00 to 4.20 cm),which was no significant statistically difference(P=0.348).The length of the MCA and ICA initiation points was 3.22±0.75 cm(1.70 to 5.70 cm)measured intraoperatively using sterile isometric filaments and 3.36±0.72cm(2.05 to 5.83 cm)measured by 3D-CT vascular reconstruction,which was a statistical difference(P<0.001).Conclusions:1.The relative spatial position between the superior and inferior mesenteric vessels and their branches as visualized by 3D-CT vascular reconstruction technique is consistent with the actual anatomy of the patients,while when the vessel diameter is thin,there is a possibility of failure of vascular reconstruction,which may cause misjudgment of the surgeon’s intraoperative dissection of the vessel.2.There are limitations in the 3D-CT vascular reconstruction technique to show the length relationship between arteries and veins,and there are some differences in the relative lengths of superior and inferior mesenteric arteries and their branches between the 3D-CT vascular reconstruction technique and the actual lengths measured during surgery,but in this study,the difference in the lengths of the vessels measured between the same patients had a manageable effect on the vascular dissection during surgery,and the relationship between the lengths of the vessels to be dissected during surgery measured in advance can provide a reference value for surgery.3.This study examines the importance of evaluating vascular anatomical changes in each patient undergoing colon cancer surgery.Preoperative 3D-CT vascular reconstruction techniques can improve the understanding of the superior and inferior mesenteric vessels and their branching variants and help reduce unintended vascular injury during radical colorectal cancer surgery. |
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