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The Role of Anatomical Dissection in Defining Colic and Small Bowel Artery Lymphovascular Bundles in the D3 Volume of Small and Large Bowel Mesentery

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Classification of the colonic splenic flexure based on three-dimensional CT analysis.

K Kawai¹, H Nozawa¹, K Hata¹

¹Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo,Japan.

|February 20, 2021

Summary

Classifying splenic flexure position using 3D coordinates helps predict surgical time. The lateral position is associated with significantly longer splenic flexure mobilization during colorectal surgery.

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Area of Science:

Colorectal Surgery
Surgical Anatomy
Medical Imaging

Background:

Mobilizing the splenic flexure is a complex step in colorectal resections.
Variability in splenic flexure anatomy presents surgical challenges.
A standardized classification system is needed to predict mobilization difficulty.

Purpose of the Study:

To classify the splenic flexure's anatomical position using 3D coordinates.
To correlate splenic flexure position with surgical mobilization time.
To improve preoperative planning in colorectal surgery.

Main Methods:

Retrospective analysis of CT images from 319 colorectal cancer patients.
Classification of splenic flexure position (caudal, cranial, lateral) using 3D coordinates of splenic and left renal hilum.
Analysis of laparoscopic colectomy procedure times for complete splenic flexure mobilization.

Main Results:

Three splenic flexure positions were identified: caudal (100), cranial (118), and lateral (101).
Lateral position was independently associated with male sex, older age, and increased body weight.
Mobilization time was significantly longer (78.7 min) in the lateral group compared to caudal (41.8 min) and cranial (43.2 min) groups.

Conclusions:

Three-dimensional coordinate-based classification of splenic flexure anatomy is feasible.
The lateral splenic flexure position predicts a significantly longer operative time for mobilization.
This classification aids in anticipating and managing surgical complexity in colorectal procedures.