Navigation for laparoscopic gastrectomy with 3-dimensional computed tomography (3D-CT)

Early-stage gastric cancer is one relatively well-explored target for laparoscopic resection. Systemic lymphadenectomy is considered an essential component of gastrectomy, however, it may not be easy even with extensive experience. It is convenient for the laparoscopists, therefore, to be given preoperatively thorough information regarding the vessels anatomy of the celiac branches around the stomach for each patient.

Between July 2001 and January 2006, 41 patients with gastric carcinoma scheduled for surgery underwent 3-dimensional computed tomography (3D-CT) examination at Nagoya University Hospital. From the 3D-CT images, information regarding the vessels that are dissected during surgery for gastric cancer was obtained, and the branching patterns of those were analyzed.

The left gastric artery and the right gastroepiploic artery were detected in all 41 cases, while the right gastric artery was detected only in 22 cases (53.7%). Variations in the origin of the left gastric and right gastroepiploic arteries were not observed. However, there was a considerable variation in the origin of the right gastric artery, with 50.0% branching from the proper hepatic artery, 22.7% from the left hepatic artery, and 13.6% from the gastroduodenal artery. In 4 cases (9.7%), the left hepatic artery was found to originate from the left gastric artery.

Preoperative knowledge of the basic vascular patterns obtained through 3D-CT imaging is a useful guide to safely perform laparoscopic gastrectomy, although further improvements in the processing of more detailed imaging is needed.