J.Jpn. Surg. Soc.. 118(1): 31-37, 2017

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Feature topic

MINIMALLY INVASIVE SURGERY FOR COLORECTAL CANCER BASED ON VIRTUAL SURGICAL ANATOMY

For advanced right colon cancer, we perform lymph node dissection exposing the so-called surgical trunk. For the resection of advanced distal sigmoid/rectal cancer, we routinely perform lymph node dissection around the root of the inferior mesenteric artery, preserving the left colic artery. To perform either of these procedures safely, it is important to know the precise vascular anatomy with individual variations. However, there are major issues in laparoscopic surgery, such as a lack of tactile sensation and limited visual field. To overcome these issues and identify the vascular anatomy of each patient accurately, we have applied integrated three-dimensional computed tomography (3D-CT) imaging as a preoperative simulation and for intraoperative navigation since July 2000. Integrated 3D-CT imaging appears to be useful, especially for cancer located around the left flexure of the transverse colon, where major variations in vascular anatomy occur. Using the no-touch technique appropriately with the precise determination of laparoscopic surgical anatomy based on simulation and navigation by integrated 3D-CT imaging for each patient, systematic lymphadenectomy in addition to lateral lymph node dissection with tailor-made vascular laparoscopic dissection for the treatment of advanced lower rectal cancer appears to be feasible and a more meticulous approach compared with conventional open surgery.

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