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Vascular Map Combined with CT Colonography for Evaluating Candidates for Laparoscopic Colorectal Surgery.

Flor N, Campari A, Ravelli A, Lombardi MA, Pisani Ceretti A, Maroni N, Opocher E, Cornalba G - Korean J Radiol (2015)

Bottom Line: Moreover, mesenteric vessels have extreme variations in terms of their courses and numbers.We describe the benefit of using an abdominal vascular map created by CE-CTC in laparoscopic colorectal surgery candidates.We describe patients with different diseases (colorectal cancer, diverticular disease, and inflammatory bowel disease) who underwent CE-CTC just prior to laparoscopic surgery.

View Article: PubMed Central - PubMed

Affiliation: Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, Milan 20142, Italy. ; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan 20142, Italy.

ABSTRACT
Contrast-enhanced computed tomography colonography (CE-CTC) is a useful guide for the laparoscopic surgeon to avoid incorrectly removing the colonic segment and the failure to diagnose of synchronous colonic and extra-colonic lesions. Lymph node dissection and vessel ligation under a laparoscopic approach can be time-consuming and can damage vessels and organs. Moreover, mesenteric vessels have extreme variations in terms of their courses and numbers. We describe the benefit of using an abdominal vascular map created by CE-CTC in laparoscopic colorectal surgery candidates. We describe patients with different diseases (colorectal cancer, diverticular disease, and inflammatory bowel disease) who underwent CE-CTC just prior to laparoscopic surgery.

No MeSH data available.


Related in: MedlinePlus

53-year-old woman with sigmoid chronic diverticulitis was referred for surgery because of symptomatic disease.A, B. Pre-operative computed tomography colonography to assess presence of diverticula (arrowhead in A) and sigmoid colon wall thickening (arrowhead in B) related to disease. C, D. Three-dimensional-fused images demonstrate sigmoid arteries (SAs) branching from left colic artery (LCA) and accessory left colic artery (ALCA) branching from middle colic artery (MCA); LCA and SAs run anteriorly to inferior mesenteric vein (IMV). ICA = ileocolic artery, IMA = inferior mesenteric artery, SMA = superior mesenteric artery, SRA = superior rectal artery
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Figure 4: 53-year-old woman with sigmoid chronic diverticulitis was referred for surgery because of symptomatic disease.A, B. Pre-operative computed tomography colonography to assess presence of diverticula (arrowhead in A) and sigmoid colon wall thickening (arrowhead in B) related to disease. C, D. Three-dimensional-fused images demonstrate sigmoid arteries (SAs) branching from left colic artery (LCA) and accessory left colic artery (ALCA) branching from middle colic artery (MCA); LCA and SAs run anteriorly to inferior mesenteric vein (IMV). ICA = ileocolic artery, IMA = inferior mesenteric artery, SMA = superior mesenteric artery, SRA = superior rectal artery

Mentions: The branching pattern of the superior mesenteric artery (SMA) must be assessed before a right hemicolectomy and right transverse colon surgery. The middle colic artery (MCA) and the ileocolic artery (ICA) are present in almost all patients, whereas the right colic artery (RCA) is present in about 50% of cases (Figs. 1, 2). The inconsistency in the presence of the accessory left colic artery (ALCA), known as the artery of Riolan, originates from the SMA or MCA and anastomoses with the left colic artery (LCA), feeding the transverse colon (Figs. 3, 4). The common origin of the MCA, RCA, and ICA (Fig. 5) has been described (89). The most significant variant to be considered during laparoscopic right hemicolectomy is the relationship between the colic arteries and the superior mesenteric vein (SMV); arteries cross anterior to the SMV in most patients, but a posterior crossing pattern of the ICA, MCA, or RCA is also common (Figs. 5, 6). The ICA runs posteriorly to the SMV in 67% of cases (8). It is important to locate the ALCA and the branching pattern of the inferior mesenteric artery (IMA) when planning left transverse colon surgery and left hemicolectomy. The LCA is absent in 12% of individuals (Fig. 7) (14). The same considerations can be applied to sigmoid colon and rectal surgery. Moreover, pre-operative planning for sigmoidectomy should include an evaluation of the sigmoid artery (SA) branching pattern because the IMA can be preserved if the SAs are selectively ligated. The number of SAs varies and they can either originate from the IMA or LCA (Figs. 2, 4, 7) (15). The relationship between arteries and the inferior mesenteric vein (IMV) can also vary: LCA and SAs can either cross anteriorly or posteriorly to the IMV (Figs. 8, 9). Because of their close proximity, the relationships between the LCA, SAs, and the left gonadic vein and ureter must be assessed. The origins of other splanchnic arteries from the SMA or IMA must also be considered be. For example, right hepatic artery frequently branches from the SMA (Fig. 7) (15). Variants in mesenteric vein drainage should also be evaluated (Fig. 8).


Vascular Map Combined with CT Colonography for Evaluating Candidates for Laparoscopic Colorectal Surgery.

Flor N, Campari A, Ravelli A, Lombardi MA, Pisani Ceretti A, Maroni N, Opocher E, Cornalba G - Korean J Radiol (2015)

53-year-old woman with sigmoid chronic diverticulitis was referred for surgery because of symptomatic disease.A, B. Pre-operative computed tomography colonography to assess presence of diverticula (arrowhead in A) and sigmoid colon wall thickening (arrowhead in B) related to disease. C, D. Three-dimensional-fused images demonstrate sigmoid arteries (SAs) branching from left colic artery (LCA) and accessory left colic artery (ALCA) branching from middle colic artery (MCA); LCA and SAs run anteriorly to inferior mesenteric vein (IMV). ICA = ileocolic artery, IMA = inferior mesenteric artery, SMA = superior mesenteric artery, SRA = superior rectal artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499546&req=5

Figure 4: 53-year-old woman with sigmoid chronic diverticulitis was referred for surgery because of symptomatic disease.A, B. Pre-operative computed tomography colonography to assess presence of diverticula (arrowhead in A) and sigmoid colon wall thickening (arrowhead in B) related to disease. C, D. Three-dimensional-fused images demonstrate sigmoid arteries (SAs) branching from left colic artery (LCA) and accessory left colic artery (ALCA) branching from middle colic artery (MCA); LCA and SAs run anteriorly to inferior mesenteric vein (IMV). ICA = ileocolic artery, IMA = inferior mesenteric artery, SMA = superior mesenteric artery, SRA = superior rectal artery
Mentions: The branching pattern of the superior mesenteric artery (SMA) must be assessed before a right hemicolectomy and right transverse colon surgery. The middle colic artery (MCA) and the ileocolic artery (ICA) are present in almost all patients, whereas the right colic artery (RCA) is present in about 50% of cases (Figs. 1, 2). The inconsistency in the presence of the accessory left colic artery (ALCA), known as the artery of Riolan, originates from the SMA or MCA and anastomoses with the left colic artery (LCA), feeding the transverse colon (Figs. 3, 4). The common origin of the MCA, RCA, and ICA (Fig. 5) has been described (89). The most significant variant to be considered during laparoscopic right hemicolectomy is the relationship between the colic arteries and the superior mesenteric vein (SMV); arteries cross anterior to the SMV in most patients, but a posterior crossing pattern of the ICA, MCA, or RCA is also common (Figs. 5, 6). The ICA runs posteriorly to the SMV in 67% of cases (8). It is important to locate the ALCA and the branching pattern of the inferior mesenteric artery (IMA) when planning left transverse colon surgery and left hemicolectomy. The LCA is absent in 12% of individuals (Fig. 7) (14). The same considerations can be applied to sigmoid colon and rectal surgery. Moreover, pre-operative planning for sigmoidectomy should include an evaluation of the sigmoid artery (SA) branching pattern because the IMA can be preserved if the SAs are selectively ligated. The number of SAs varies and they can either originate from the IMA or LCA (Figs. 2, 4, 7) (15). The relationship between arteries and the inferior mesenteric vein (IMV) can also vary: LCA and SAs can either cross anteriorly or posteriorly to the IMV (Figs. 8, 9). Because of their close proximity, the relationships between the LCA, SAs, and the left gonadic vein and ureter must be assessed. The origins of other splanchnic arteries from the SMA or IMA must also be considered be. For example, right hepatic artery frequently branches from the SMA (Fig. 7) (15). Variants in mesenteric vein drainage should also be evaluated (Fig. 8).

Bottom Line: Moreover, mesenteric vessels have extreme variations in terms of their courses and numbers.We describe the benefit of using an abdominal vascular map created by CE-CTC in laparoscopic colorectal surgery candidates.We describe patients with different diseases (colorectal cancer, diverticular disease, and inflammatory bowel disease) who underwent CE-CTC just prior to laparoscopic surgery.

View Article: PubMed Central - PubMed

Affiliation: Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, Milan 20142, Italy. ; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan 20142, Italy.

ABSTRACT
Contrast-enhanced computed tomography colonography (CE-CTC) is a useful guide for the laparoscopic surgeon to avoid incorrectly removing the colonic segment and the failure to diagnose of synchronous colonic and extra-colonic lesions. Lymph node dissection and vessel ligation under a laparoscopic approach can be time-consuming and can damage vessels and organs. Moreover, mesenteric vessels have extreme variations in terms of their courses and numbers. We describe the benefit of using an abdominal vascular map created by CE-CTC in laparoscopic colorectal surgery candidates. We describe patients with different diseases (colorectal cancer, diverticular disease, and inflammatory bowel disease) who underwent CE-CTC just prior to laparoscopic surgery.

No MeSH data available.


Related in: MedlinePlus