Virtual laparoscopic imaging for performing central vascular ligation through laparoscopic surgery for transverse colon cancer

Excerpt

The need for complete mesocolic excision (CME) in colon cancer is well recognized [1]. Achieving CME requires central vascular ligation (CVL) at the root of the feeding artery of the colon cancer [2]. However, in transverse colon cancer, the complex vessel anatomy surrounding the middle colic artery (MCA, often the feeding artery) makes CVL challenging. Therefore, we present a new technique, termed virtual laparoscopic imaging (VLI), developed from footage taken using a simulated laparoscopic exploration. The scope was inserted into and moved through the abdominal cavity via an umbilical surgical port in a manner similar to actual laparoscopic surgery. This procedure involved using a 64-row multi-detector computed tomography (CT) device (GE Healthcare, Little Chalfont, United Kingdom) to take 1-mm slice CT images once patients were injected with 600 mg/kg of iopamidol using an automatic syringe. These vascular data were loaded onto a three-dimensional (3D) image analysis workstation (system volume analyzer) (Synapse VINCENT, Fujifilm, Tokyo, Japan) that automatically removed data from bone tissue and irrelevant local organ tissue to preoperatively create all VLI footage. This footage is able to reproduce actual surgical views observed intraoperatively and allows surgeons to preoperatively simulate surgical procedures. …