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Laparoscopic assisted gastrectomy and 3D-CT

Romeo Giuli MD, resident.
School of General and Emergency Surgery.
University of Siena.   Italy.

February 2003.     Review Article.

To the first article
To the second article
To the third article

The incidence of lymph node metastasis in early gastric cancer varies from 5.7% to 29%. Because gastric cancer, even in the early stages of invasion, tends to metastasize beyond the perigastric lymph nodes, it is important that LGCS (laparoscopic gastric cancer surgery) accommodates the basic oncologic principles to the same extent as open surgery does.

When submucosal invasion was preoperatively suspected, Sang-Woong Lee et al. needed to remove the lymph nodes along with the common hepatic artery, the celiac axis, the left gastric artery, and the proximal splenic artery, concomitant with dissection of the perigastric nodes.
So it is necessary to devise an advanced technique that provides a secure and safe method for performing LGCS.

Comprehension of the origin and course of main vessels during lymphadenectomy is of primary surgical importance; this can be confirmed with 3D-CT imaging. Because knowledge of the gastric vasculature is essential for preoperative planning of LGCS, the authors have introduced MDCT (Multidetector-row helical CT ) into the preoperative inspection.
To date, the visibility of upper abdominal vessels by 3D-CT imaging has not been reported. Three-dimensional CT imaging successfully depicted the right gastric artery, the left gastric artery, and the left gastric vein-important information during lymph node dissection.
Three-dimensional CT imaging has various advantages. First, 3D-CT angiography is a minimally invasive vascular imaging method that is less expensive than conventional diagnostic angiography. Second, the stomach, the main arteries, and veins are integrated in one image. Third, 3D-CT imaging can be visualized interactively from any viewpoint. Eventually, surgery may be performed with ease by allowing the surgeon to comprehend the entire surgical area in a three-dimensional manner with the help of 3D-CT imaging compared with two-dimensional visibility in laparoscopy. Although 3D-CT image reconstruction is still time consuming, with more technical developments in hardware and software, this problem might be solved in the near future ( 1 ).


1) Sang-Woong Lee, Hisashi Shinohara et al. Preoperative Simulation of Vascular Anatomy by Three-Dimensional Computed Tomography Imaging in Laparoscopic Gastric Cancer Surgery. J Am Coll Surg 2003;197:927-936. Pub Med

2) Seto Y, Shimoyama S, Kitayama J, et al. Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer. Gastric Cancer 2001;4:34-38. Pub Med

3) Marescaux J, Clement JM, Tassetti V, et al. Virtual reality applied to hepatic surgery simulation: the next revolution. Ann Surg 1998; 228:627-634. Pub Med

4) Wigmore SJ, Redhead DN, Yan XJ, et al. Virtual hepatic resection using three-dimensional reconstruction of helical computed tomography angioportograms. Ann Surg 2001;233:221-226. Pub Med

5) Ott DJ. Virtual gastroscopy: a new look at the stomach. Am J Gastroenterol 2000;95:1084-1085. Pub Med

6) Shioyama Y, Kimura M, Horihata K, et al. Peripancreatic arteries in thin-section multislice helical CT. Abdom Imaging 2001; 26:234-242. Pub Med

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