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Laparoscopic splenic hilar lymph node dissection for proximal gastric cancer using integrated three-dimensional
Takahiro Kinoshita1, Hidehito Shibasaki2, Naoki Enomoto2
1Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. takkinos@east.ncc.go.jp.
Surgical Endoscopy
|August 28, 2015
Summary
Three-dimensional (3D) simulation enhances laparoscopic lymph node dissection during gastrectomy. This technology improves the retrieval of lymph nodes (LNs) without increasing operative time or complications.
Area of Science:
- Surgical Oncology
- Medical Imaging
- Minimally Invasive Surgery
Background:
- Laparoscopic lymph node (LN) dissection, particularly around the splenic artery (Station No. 11d) and hilum (Station No. 10), is complex due to intricate splenic vessel anatomy.
- This anatomical complexity presents a significant challenge for surgeons even with extensive experience.
Purpose of the Study:
- To investigate the utility of integrated three-dimensional (3D) computed tomography (CT) simulations in facilitating laparoscopic total gastrectomy (LTG) with splenic hilar LN dissection.
- To evaluate the consistency of 3D virtual models with actual surgical anatomy and assess the impact of 3D simulation on surgical outcomes.
Main Methods:
- The study involved 20 LTG procedures, including LTG with pancreatic and spleen preservation (LTG + PSP) and LTG with splenectomy (LTG + S).
- Clinical data and 3D simulation information were collected and analyzed, comparing outcomes with a control group of 10 patients who underwent surgery prior to 3D simulation introduction.
Main Results:
- 3D simulations accurately depicted vascular architecture and morphology, showing good consistency with intraoperative findings.
- While operation time, blood loss, and complication rates were similar between groups, the number of retrieved Station No. 10 LNs significantly increased with 3D simulation use (p=0.006).
Conclusions:
- Integrated 3D CT simulation technology can simplify challenging laparoscopic lymph node dissections around the splenic hilum.
- This technology has the potential to improve surgical quality and may lead to broader adoption in complex oncologic resections.
