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Surgical Endoscopy

, Volume 33, Issue 1, pp 309–314 | Cite as

Application of ultrasonography to high-tie and low-tie vascular ligation of the inferior mesenteric artery in laparoscopic colorectal cancer surgery: technical notes

  • Yoshihiko SadakariEmail author
  • Shuntaro Nagai
  • Vittoria Vanessa Velasquez
  • Kinuko Nagayoshi
  • Hayato Fujita
  • Kenoki Ohuchida
  • Tatsuya Manabe
  • Takao Ohtsuka
  • Masafumi Nakamura
Dynamic Manuscript

Abstract

Background

Two ligation techniques can be applied in laparoscopy for left-sided colorectal cancer: (1) high-tie (HT), transection at the level of the inferior mesenteric artery (IMA); and (2) low-tie (LT), transection below the IMA, at the level of superior rectal artery (SRA), preserving the left colic artery (LCA). However, even with preoperative images, it can still be a challenge to identify these structures due to intraoperative individual conditions. In this study, we assess the use intraoperative ultrasonography (IOUS) to aid us in identifying the IMA and its branches to the SRA, LCA, and sigmoid artery.

Methods

We performed IOUS in 18 patients diagnosed with left-sided colorectal cancer. Preoperatively, a three-dimensional computed tomography (3D-CT) angiography was obtained in majority of the patients, to visualize the IMA and its branches. Two patients were contraindicated to receive a contrast study, hence, was unable to undergo 3D-CT angiography. The resected specimen was grossly examined for the study. The bifurcation types were identified and compared using different modalities: preoperative 3D-CT, IOUS, and gross examination of the resected specimen.

Results

The branching of the IMA revealed by IOUS was consistent to the findings preoperatively by the 3D-CT and postoperatively by the resected specimen. The IOUS result of the two patients without preoperative 3D-CT evaluation was also consistent with the post-operative bifurcation type.

Conclusions

IOUS is an easy and feasible modality which aids in detecting the branching of the IMA during LT and HT ligation in laparoscopic left-sided colorectal surgery. It can serve as an adjunct modality for 3D-CT angiography and can also be considered a safe alternative option for cases wherein 3D-CT angiography is unavailable.

Keywords

Intraoperative ultrasonography Laparoscopic colorectal surgery Vascular ligation Low-tie transection High-tie transection Colorectal cancer 

Notes

Author contribution

YS, SN, KN, HF, and TM conception and design; YS, SN, KN, HF, and TM acquisition of data; YS, SN, KN, HF, and TM analysis and interpretation of data; YS, VVV, KO, TO, and MN drafting the article or revising it critically for important intellectual content; YS, SN, KN, HF, VVV, KO, TM, TO, and MN final approval of the version to be published. YS thought up this technique. YS and SN are the operation attending surgeons in the video.

Compliance with ethical standards

Disclosures

Yoshihiko Sadakari, Shuntaro Nagai, Vittoria Vanessa Velasquez, Kinuko Nagayoshi, Hayato Fujita, Kenoki Ohuchida, Tatsuya Manabe, Takao Ohtsuka, and Masafumi Nakamura have no conflicts of interest or financial ties to disclose.

Supplementary material

Video S1: LT transection was applied in a 53-year-old male with rectal cancer. 3D-CT angiography showed that the LCA and SA arose from the IMA at the same point. The SRA was ligated and transected at the root. Abbreviations: LT, low-tie; 3D-CT, three-dimensional CT; LCA, left colic artery; SA, sigmoid artery; IMA, inferior mesenteric artery; SRA, superior rectal artery. (WMV 38130 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Yoshihiko Sadakari
    • 1
    Email author
  • Shuntaro Nagai
    • 1
  • Vittoria Vanessa Velasquez
    • 1
  • Kinuko Nagayoshi
    • 1
  • Hayato Fujita
    • 1
  • Kenoki Ohuchida
    • 1
  • Tatsuya Manabe
    • 1
    • 2
  • Takao Ohtsuka
    • 1
  • Masafumi Nakamura
    • 1
  1. 1.Department of Surgery and Oncology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Department of Gastroenterology and General Surgery, Faculty of MedicineSaga UniversitySagaJapan

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