Usefulness of three-dimensional angiographic analysis of perigastric vessels before laparoscopic gastrectomy

Abstract

Background Recognition of perigastric vessel anatomy is important to safely perform gastric surgery, especially in the case of laparoscopic gastrectomy. This study was designed to reevaluate the efficacy of preoperative three-dimensional (3D) angiography reconstructed from enhanced multidetector-row computed tomography (MDCT) data and to classify right gastric artery (RGA) branching patterns. Methods Perigastric vessel anatomy was preoperatively analyzed using MDCT-based 3D angiography reconstructed by computer software in patients undergoing laparotomic (n = 75) and laparoscopic (n = 25) gastrectomy. Results were compared with intraoperative findings in all cases, and were also compared with maximum intensity projection (MIP) imaging, which is similar to conventional angiography, in 10 patients. Results Preoperative diagnoses by 3D angiography were identical to intraoperative findings. The rates of branching patterns of the celiac artery and left gastric vein were comparable with previous reports. The detection rate of the right gastric artery (RGA) was 77.0 %. Branching patterns of the hepatic artery were classified into four types: right hepatic artery (RHA) ? left hepatic artery (LHA) type, replaced RHA ? LHA type, RHA ? replaced LHA type, and replaced RHA ? replaced LHA type. RGA ramification patterns were classified into three types according to hepatic arterial running patterns: distal (68.8 %), proximal (14.3 %), and caudal (16.9 %). Because of vessel overlapping, RGA ramified points were misdiagnosed under MIP images in two of ten cases (20 %). Conclusions Preoperative 3D angiography is useful for a new system of classifying RGA ramification patterns into three types. With this system, surgeons can perform laparoscopic gastrectomy with lymph node dissection more safely.

Clinical application of a surgical navigation system based on virtual laparoscopy in laparoscopic gastrectomy for gastric cancer

“…As described in the surgeons' feedback, the surgeon can intuitively understand the anatomical structures by observing the virtual laparoscopic views. Since there are many variations in branching patterns of major blood vessels in the upper abdomen, appreciation of patient-specific vascular anatomy is vital for laparoscopic gastrectomy [22,23]. The virtual laparoscopic views make recognition of the branching patterns of vessels easy during surgery.…”

“…In laparoscopic gastrectomy for gastric cancer, stomach and lymph nodes need to be removed without damage to blood vessels feeding or draining adjacent structures and whatever part of the stomach is retained. The task is significantly complicated by the number of variants in major vessel branching patterns in the upper abdomen [22,23]. Abdominal fat can also obscure the surgical scene making navigation difficult.…”

Three‐dimensional fusion images combining CT gastrography and CT angiography for early gastric cancer: Pilot experiences of preoperative simulation prior to totally laparoscopic gastrectomy

“…Imaging techniques such as an MDCT have dramatically progressed in recent years. In this era of laparoscopic surgery, it is becoming more important to properly understand vessel anatomy using preoperative images, as reported in our earlier studies . In this pilot study, we report a novel method of preoperative simulation using 3DFI in which a combination of CTG and CT angiography (CTA) was used before TLG.…”

“…The patient's position was changed to the 30° right posterior oblique position just before scanning to obtain sufficient distension of the upper stomach. The CT protocol was described in our previous reports . Images were obtained using an MDCT scanner (Aquilion 64; Toshiba Medical Systems, Tokyo, Japan).…”

Optimal port placement planning method for laparoscopic gastrectomy

“…Since these blood vessels have many branching patterns, the anatomical configuration of the blood vessels is vital for laparoscopic gastrectomy [10,11]. Therefore, we utilize the relationships between the target blood vessel location and port location as the conditions that determine optimal port placement.…”