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The use of ultrasound in central vascular ligation during laparoscopic right-sided colon cancer surgery: technical notes

  • Technical Note
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Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Complete mesocolic excision (CME) with central vascular ligation (CVL) requires the surgeon to sharply dissect the mesocolon and approach the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) for ligation of the supplying vessels relating to right-sided colon cancer at their origin. Even with preoperative images, it can still be challenging to identify these structures during laparoscopic surgery because of various intraoperative conditions. The aim of this study was to assess the efficacy of intraoperative ultrasound (IOUS) for identification of blood vessels during right-sided colon cancer surgery.

Methods

We performed IOUS on 19 patients diagnosed with right-sided colon cancer at our institution, in January–October 2020. Preoperatively, a three-dimensional computed tomography (3D-CT) angiogram was obtained for the majority of patients to visualize the SMA, SMV, and their respective branches. The running position of the ileocolic artery (ICA) and right colic artery (RCA) related to the SMV and the presence of the middle colic artery were identified and compared using preoperative 3D-CT, IOUS, and intraoperative findings.

Results

Nineteen patients [seven men and 12 women with a mean age of 73.9 ± 8.4 years (range 58–82 years)] were studied, including some with a body mass index of > 30 kg/m2, locally advanced cancer, and severe adhesion. There were IOUSs that detected the SMA, SMV, and their tributaries in all patients. The positional relationships between the SMV and the ICA and RCA revealed by IOUS were consistent with the preoperative and intraoperative findings.

Conclusion

IOUS is a safe, feasible, and reproducible technique that can assist in detecting the branching of the SMA and SMV during CME with CVL in laparoscopic right-sided colon cancer surgery, regardless of individual conditions.

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Fig. 1
Fig. 2

Data availability

All data analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank Gareth Jenkins for accompanying the video with an audio narration and Paul Mitchell from Edanz Group (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript.

Funding

The authors have no financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, St Mary’s Hospital, Kurume, Japan

    Y. Sadakari, N. Yoshida, A. Iwanaga, A. Saruwatari, K. Kaneshiro, G. Hirokata, T. Aoyagi, K. Tamehiro, T. Ogata & M. Taniguchi

  2. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Y. Sadakari & K. Kaneshiro

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Contributions

Conception and design: YS, NY, AI, AS, TO, and MT. Data acquisition: YS, NY, AI, and AS. Data analysis and interpretation: YS, NY, KK, GH, and TA. Article drafting or critical revisions for important intellectual content: YS, NY, KT, TO, and MT. Final approval for publishing was given by YS, NY, AI, AS, KK, GH, TA, KT, TO, and MT. YS developed this technique. YS and NY are the attending surgeons in the video.

Corresponding author

Correspondence to Y. Sadakari.

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Conflict of interest

Yoshihiko Sadakari, Naohiro Yoshida, Ayako Iwanaga, Akihiro Saruwatari, Kazuhisa Kaneshiro, Gentaro Hirokata, Takeshi Aoyagi, Kazuhito Tamehiro, Toshiro Ogata, and Masahiko Taniguchi have no conflicts of interest or financial ties to disclose.

Ethics approval

This study was approved by the ethics committee of St. Mary’s Hospital (19–0215). All procedures performed (laparoscopic operation and intraoperative ultrasonography) were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all patients included in the study preoperatively.

Consent for publication

Patients signed informed consent regarding publishing their clinical data and intraoperative movies.

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Sadakari, Y., Yoshida, N., Iwanaga, A. et al. The use of ultrasound in central vascular ligation during laparoscopic right-sided colon cancer surgery: technical notes. Tech Coloproctol 25, 1155–1161 (2021). https://doi.org/10.1007/s10151-021-02472-1

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