Anatomical study of the left colic artery in laparoscopic-assisted colorectal surgery
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and Other Interventional Techniques
Anatomical study of the left colic artery in laparoscopic‑assisted colorectal surgery Wei Zhang1 · Wei‑Tang Yuan1 · Gui‑xian Wang1 · Jun‑Min Song1 Received: 7 October 2018 / Accepted: 6 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background It is important for lymph node dissection around the inferior mesenteric artery (IMA) with preservation of the left colic artery (LCA) to be aware of the track and the length of the LCA. We aimed to investigate the branching pattern and trajectory of LCA and measure the distances from the root of the IMA to the origin of the LCA (D mm) and from the origin of LCA to intersection of LCA and IMV (d mm) during laparoscopic left-sided colorectal operations. Methods We analyzed 106 patients who underwent laparoscope-assisted left-side colorectal surgery during laparoscopic surgery. The branching patterns among the IMA, LCA, and sigmoidal trunk were evaluated; the trajectory of LCA was examined; the D mm and d mm were measured using a length of silk in the surgical operation. Results In 59.5% patients, the LCA arose independently from the sigmoidal trunk (type A); in 8.5% patients, the LCA and sigmoidal trunk arose from the IMA at the same point (type B); in 29.2% patients, the LCA and sigmoidal trunk had a common trunk (type C); the LCA did not exist in 2.8% (type D).The D mm and d mm for all cases ranged from 15.0 to 65.3 mm (median, 43.1 mm) and from 20.3 to 46.2 mm (median, 34.8 mm), respectively. 74.8% of the LCA went straight upper left and upward to proximal part of descending colon (type I), 25.2% went to the lower left at first, then turned to travel straight upward to proximal part of descending colon (type II). Conclusion This study showed the anatomic variations of LCA during laparoscopic left-sided colorectal operation, which would help surgeons safely perform laparoscopic surgery in the left-side colon and rectum. Keywords Anatomy · Inferior mesenteric artery · Left colic artery · Laparoscopic surgery · Colorectal cancer Laparoscope-assisted colorectal surgery is being increasingly used as a minimally invasive surgery. In left-side colon cancer surgery, proximal ligation of the inferior mesenteric artery (IMA) with radical lymphadenectomy is the accepted method of care [1–4]. However, IMA ligation possibly reduced blood flow to the anastomosis, which may increase the leakage rate [5–8]. Accordingly, some surgeons employ the technique of lymph node dissection around the IMA with preservation of the IMA and left colic artery (LCA) to maintain the blood supply of the proximal sigmoid colon [6, 9–14]. Compare to the regular way of simply doing a high ligation of the IMA, the vascular sheath is peeled off from the root of the IMA down to the bifurcation of the LCA and * Jun‑Min Song [email protected] 1
The Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1 on Jian‑She‑East Road, Zhengzhou, Henan Province, China
superior rect
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