Introducing Anatomically Correct CT-Guided Laparoscopic Right Colectomy with D3 Anterior Posterior Extended Mesenterectomy: Initial Experience and Technical Pitfalls

Gaupset, Robin; Nesgaard, Jens Marius; Kazaryan, Airazat M.; Štimec, Bojan; Edwin, Bjørn; Ignjatović, Dejan

doi:10.1089/lap.2018.0059

Cited by 17 publications

(16 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The strengths with this study are the implementation of previously quality assessed research tools including 3D CT reconstructions and 3D printing that have been validated at surgery and have shown high specificity, sensitivity, accuracy and reliability [ 4 , 45 ]. 3D Models were printed when it was deemed necessary in order to acquire better visuospatial understanding and tactile information.…”

Section: Discussionmentioning

confidence: 99%

Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background The impact of the position of the middle colic artery (MCA) bifurcation and the trajectory of the accessory MCA (aMCA) on adequate lymphadenectomy when operating colon cancer have as of yet not been described and/or analysed in the literature. The aim of this study was to determine the MCA bifurcation position to anatomical landmarks and to assess the trajectory of aMCA. Methods The colonic vascular anatomy was manually reconstructed in 3D from high-resolution CT datasets using Osirix MD and 3-matic Medical and analysed. CT datasets were exported as STL files and supplemented with 3D printed models when required. Results Thirty-two datasets were analysed. The MCA bifurcation was left to the superior mesenteric vein (SMV) in 4 (12.1%), in front of SMV in 17 (53.1%) and right to SMV in 11 (34.4%) models. Median distances from the MCA origin to bifurcation were 3.21 (1.18–15.60) cm. A longer MCA bifurcated over or right to SMV, while a shorter bifurcated left to SMV (r = 0.457, p = 0.009). The main MCA direction was towards right in 19 (59.4%) models. When initial directions included left, the bifurcation occurred left to or anterior to SMV in all models. When the initial directions included right, the bifurcation occurred anterior or right to SMV in all models. The aMCA was found in 10 (31.3%) models, following the inferior mesenteric vein (IMV) in 5 near the lower pancreatic border. The IMV confluence was into SMV in 18 (56.3%), splenic vein in 11 (34.4%) and jejunal vein in 3 (9.4%) models. Conclusion Awareness of the wide range of MCA bifurcation positions reported is crucial for the quality of lymphadenectomy performed. The aMCA occurs in 31.3% models and its trajectory is in proximity to the lower pancreatic border in one half of models, indicating that it needs to be considered when operating splenic flexure cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Data collection is prospective. All these data points have been previously published [2][3][4][9][10][11] but will be addressed in short below. While the regional ethical committee approval allows any mode of access (open [10], laparoscopic [9], and robotic assisted), the study started out through open access while laparoscopic and robotic-assisted surgery were introduced at a later point.…”

Section: Methodsmentioning

confidence: 99%

Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy

Agustsdottir

Štimec

Stroemmen

et al. 2020

Langenbecks Arch Surg

Self Cite

View full text Add to dashboard Cite

Background We aim to find the incidence of chylous ascites in patients undergoing D3 extended mesenterectomy and evaluate if a routine fat-reduced diet (FRD) has a prophylactic effect. Methods Data from 138 patients included in a D3 extended mesenterectomy trial were collected prospectively. Surgical drains and biochemical testing of drain fluid were used to find the incidence of chylous ascites among the first 39 patients, and a prophylactic fat-reduced diet was then implemented in the next 99 patients as a prophylactic measure. Results In the first 39 patients, we found that 16 (41.0%) developed chylous ascites. After the fat-reduced diet was implemented, 1 (1.0%) of 99 patients developed chylous ascites. Drain discharge was 150 vs. 80 mL daily, respectively, and a regression analysis shows the average leakage in the group with fat-reduced diet was 105 mL/day less than in the patients with no dietary restrictions (p < 0.001). There were no significant differences in the rate of other complications (Fisher exact test, one-tailed p = 0.8845), and although there was a tendency to a shorter hospital stay when given a fat-reduced diet (7.3 ± 5.4 vs. 8.9 ± 4.9 days), the difference was not significant (p = 0.19). Conclusions Chylous ascites is a very common postoperative occurrence after right colectomy with extended D3 mesenterectomy and may be prevented using a routine fat-reduced diet.

show abstract

“…The differences in the skills of the surgeon would cause differences in the operative time. If surgeons had not mastered a comprehensive understanding of vascular anatomy or advanced laparoscopic techniques[ 15 ] or if the abdominal cavity was severely adhered[ 16 ], the surgeon may enter the wrong anatomy level, leading to the destruction of a larger area of the lymphatic network and lymphatic vessels, prolonging the operative time, and increasing the incidence of CA, which was inconsistent with previous reports that considered short operative times; additionally, the occurrence of CA may be caused by incomplete sealing of lymphatic vessels and energy devices due to insufficient sealing time during laparoscopic surgery[ 6 , 9 ]. However, laparoscopy was not a risk factor in our study ( P > 0.05).…”

Section: Discussionmentioning

confidence: 99%

Nomogram for predicting chylous ascites after right colectomy

Zheng¹,

Liu²,

Chen³

et al. 2021

WJGS

View full text Add to dashboard Cite

BACKGROUND Chylous ascites following right colectomy has a high incidence which is a critical challenge. At present, there are few studies on the factors affecting chylous ascites after right colectomy and especially after D3 Lymphadenectomy. A predictive model for chylous ascites has not yet been established. Therefore, we created the first nomogram to predict the incidence of chylous ascites after right hemicolectomy. AIM To analyze the risk factors for chylous ascites after right colectomy and establish a nomogram to predict the incidence of chylous ascites. METHODS We retrospectively collected patients who underwent right hemicolectomy between January 2012 and May 2021 and were pathologically diagnosed with cancer. Multivariate logistic regression was used to analyze the influencing factors of chylous ascites and a nomogram was established. The predictive ability was assessed by the area under the receiver operating characteristic (ROC) curve. RESULTS Operative time, the type of operation (standard or extended), the number of lymph nodes retrieved, and somatostatin administration were considered important risk factors. Multivariate logistic regression and nomograms can be used to accurately predict whether chylous ascites occurs. The area under the ROC curve of the model is 0.770. The C-statistic of this model is 0.770 which indicates that it has a relatively moderate ability to predict the risk of chylous ascites. CONCLUSION We found a novel set of risk factors, created a nomogram, and validated it. The nomogram had a relatively accurate forecasting ability for chylous ascites after right hemicolectomy and can be used as a reference for risk assessment of chylous ascites and whether to prevent it after surgery.

show abstract

Introducing Anatomically Correct CT-Guided Laparoscopic Right Colectomy with D3 Anterior Posterior Extended Mesenterectomy: Initial Experience and Technical Pitfalls

Abstract: Laparoscopic right colectomy with D3APEM is feasible, associated with acceptable morbidity and fast recovery; now in readiness for introduction in specialized colorectal institutions.

Cited by 17 publications

References 39 publications

Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer

Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer

Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy

Nomogram for predicting chylous ascites after right colectomy

Contact Info

Product

Resources

About