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Lee J, Oh HK, Ahn HM, Yang IJ, Suh JW, Kim DW, Kang SB. Accessory Middle Colic Artery-Preserving Laparoscopic Splenic Flexure Mobilization With Articulated Laparoscopic Instrument. Dis Colon Rectum 2023; 66:e1128. [PMID: 37606623 DOI: 10.1097/dcr.0000000000002726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Jeehye Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Sakamoto K, Okabayashi K, Matsumoto S, Matsui S, Seishima R, Shigeta K, Kitagawa Y. Drainage pattern of the splenic flexure vein and its accompanying arteries using three-dimensional computed tomography angiography: a single-centre study of 600 patients. Colorectal Dis 2023; 25:1679-1685. [PMID: 37221647 DOI: 10.1111/codi.16610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/10/2023] [Accepted: 04/22/2023] [Indexed: 05/25/2023]
Abstract
AIM The splenic flexure has variable vascular anatomy, and the details of the venous forms are not known. In this study, we report the flow pattern of the splenic flexure vein (SFV) and the positional relationship between the SFV and arteries such as the accessory middle colic artery (AMCA). METHODS This was a single-centre study using preoperative enhanced CT colonography images of 600 colorectal surgery patients. CT images were reconstructed into 3D angiography. SFV was defined as a vein flowing centrally from the marginal vein of the splenic flexure visible on CT. AMCA was defined as the artery feeding the left side of the transverse colon, separate from the left branch of the middle colic artery. RESULTS The SFV returned to the inferior mesenteric vein (IMV) in 494 cases (82.3%), the superior mesenteric vein in 51 cases (8.5%) and the splenic vein in seven cases (1.2%). The AMCA was present in 244 cases (40.7%). The AMCA branched from the superior mesenteric artery or its branches in 227 cases (93.0% of cases with existing AMCA). In the 552 cases in which the SFV returned to the IMV, superior mesenteric vein or splenic vein, the left colic artery was the most frequent artery accompanying the SFV (42.2%), followed by the AMCA (38.1%) and the left branch of the middle colic artery (14.3%). CONCLUSIONS The most common flow pattern of the vein in the splenic flexure is from the SFV to IMV. The SFV is frequently accompanied by the left colic artery or AMCA.
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Affiliation(s)
- Kyoko Sakamoto
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shunsuke Matsumoto
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shimpei Matsui
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Seishima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Shigeta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Cirocchi R, Randolph J, Cheruiyot I, Davies RJ, Gioia S, Henry BM, Anania G, Donini A, Mingoli A, Sapienza P, Avenia S. Discontinuity of marginal artery at splenic flexure and rectosigmoid junction: A systematic review and meta-analysis. Colorectal Dis 2023. [PMID: 37317032 DOI: 10.1111/codi.16624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 02/08/2023] [Accepted: 04/02/2023] [Indexed: 06/16/2023]
Abstract
AIM The aim of this study was to provide comprehensive evidence-based assessment of the discontinuity of the marginal artery at the splenic flexure (SF) and the rectosigmoid junction (RSJ). METHOD A systematic review was conducted of literature published to 26 December 2022 in the electronic databases PubMed, SCOPUS and Web of Science to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using the Metafor package in R. The primary outcomes were the pooled PPEs of the marginal artery at the SF and the RSJ. The secondary outcome was the size of vascular anastomoses. RESULTS A total of 21 studies (n = 2,864 patients) were included. The marginal artery was present at the splenic flexure in 82% (95% CI: 62-95) of patients. Approximately 81% (95% CI: 63-94%) of patients had a large macroscopic anastomosis, while the remainder (19%) had small bridging ramifications forming the vessel. The marginal artery was present at the RSJ in 82% (95% CI: 70-91%) of patients. CONCLUSION The marginal artery may be absent at the SF and the RSJ in up to 18% of individuals, which may confer a higher risk of ischaemic colitis. As a result of high interstudy heterogeneity noted in our analysis, further well-powered studies to clarify the prevalence of the marginal artery at the SF and the RSJ, as well as its relationship with other complementary colonic collaterals (intermediate and central mesenteric), are warranted.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, USA
| | - Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
- International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Sara Gioia
- Section of Legal Medicine, Hospital of Terni, Terni, Italy
| | | | - Gabriele Anania
- Department of Medical Science, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Annibale Donini
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Paolo Sapienza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
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Ogi Y, Egi H, Ishimaru K, Koga S, Yoshida M, Kikuchi S, Akita S, Sugishita H, Matsumoto H, Shimokawa T, Takeuchi A, Watanabe Y. Cadaveric and CT angiography study of vessels around the transverse colon mesentery. World J Surg Oncol 2023; 21:36. [PMID: 36747176 PMCID: PMC9901106 DOI: 10.1186/s12957-023-02919-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Laparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon are unknown. We investigated variation of the MCA using computed tomography angiography (CTA) and cadaver specimen and the relationship between the superior mesenteric vein (SMV) and MCA using CTA. The classification of vessels around the transverse colon may lead to safer and reliable surgery. METHODS This study included 505 consecutive patients who underwent CTA in our institution from 2014 to 2020 and 44 cadaver specimens. Vascular anatomical classifications and relationships were analyzed using CT images. RESULTS The MCA was defined as the arteries arising from the superior mesenteric artery (SMA) that flowed into the transverse colon at the distal ends. The classifications were as follows: type I, branching right and left from common trunk; type II, the right and left branches bifurcated separately from the SMA; and type III, the MCA branched from a vessel other than the SMA. Type II was subclassified into two subtypes, type IIa with one left branch and type IIb with two or more left branches from SMA. In the CTA and cadaver studies, respectively, the classifications were as follows: type I, n = 290 and n = 31; type IIa, n = 211 and n = 13; type IIb, n = 3 and n = 0; and type III, n = 1 and n = 0. We classified the relationship between the MCA and left side of the SMV into three types: type A, a common trunk runs along the left edge of the SMV (n = 173; 59.7%); type B, a right branch of the MCA runs along the left edge of the SMV (n = 116; 40.0%); and type C, the MCA runs dorsal of the SMV (n = 1; 0.3%). CONCLUSIONS This study revealed that The MCA branching classifications and relationship between the SMV and MCA. Preoperative CT angiography may be able to reliably identify vessel variation, which may be useful in clinical practice.
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Affiliation(s)
- Yusuke Ogi
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Hiroyuki Egi
- Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime, 454 Shitsukawa791-0295, Japan.
| | - Kei Ishimaru
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Shigehiro Koga
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Motohira Yoshida
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Satoshi Kikuchi
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Satoshi Akita
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Hiroki Sugishita
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Hironori Matsumoto
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Tetsuya Shimokawa
- grid.255464.40000 0001 1011 3808Division of Developmental Biology and Functional Genomics, Graduate School of Medicine, Ehime University, 454 Shitsukawa, Toon City, Ehime 795-0295 Japan
| | - Akihide Takeuchi
- grid.255464.40000 0001 1011 3808Division of Developmental Biology and Functional Genomics, Graduate School of Medicine, Ehime University, 454 Shitsukawa, Toon City, Ehime 795-0295 Japan
| | - Yuji Watanabe
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
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Redefining the collateral system between the superior mesenteric artery and inferior mesenteric artery: A novel classification, by Kuzu et al. Colorectal Dis 2021; 23:1298. [PMID: 34128590 DOI: 10.1111/codi.15741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Jansen-Winkeln B, Mehdorn M, Lange U, Köhler H, Chalopin C, Gockel I. Precision Surgery In Rectal Resection With Hyperspectral and Fluorescence Imaging And Pelvic Intraoperative Neuromonitoring (With Video). Surg Technol Int 2021; 38:154-158. [PMID: 34081769 DOI: 10.52198/21.sti.38.cr1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Oncologic visceral surgery has recently been revolutionized by robotics, artificial intelligence (AI), sparing of functionally important structures and innovative intraoperative imaging tools. These techniques enable new dimensions of precision surgery and oncology. Currently, data-driven, cognitive operating rooms are standing at the forefront of the latest technical and didactic developments in abdominal surgery. Rectal low anterior resection with total mesorectal excision (TME) for lower- and middle-third rectal cancer is a challenging operation due to the narrow pelvis and the tender guiding structures. Thus, new approaches have been needed to simplify the procedure and to upgrade the results. The combination of robotics with pelvic intraoperative neuromonitoring (pIONM) and new possibilities of visualization, such as multi- and hyperspectral imaging (MSI / HSI) or fluorescence imaging (FI) with indocyanine green (ICG) is a forward-looking modality to enhance surgical precision and reduce postoperative complications while improving oncologic and functional outcomes with a better quality of life. The aim of our video-paper is to show how to achieve maximum precision by combining robotic surgery with pelvic intraoperative neuromonitoring and new imaging devices for rectal cancer.
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Affiliation(s)
- Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Mathias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Undine Lange
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Hannes Köhler
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - Claire Chalopin
- Innovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
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