High ligation of the inferior mesenteric artery with nerve-sparing in laparoscopic surgery for advanced colorectal cance
- PDF / 493,479 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 98 Downloads / 193 Views
VIDEO FORUM
High ligation of the inferior mesenteric artery with nerve‑sparing in laparoscopic surgery for advanced colorectal cancer Y. Sun1 · Z. C. Zhang1 · Y. D. Zhou1 · P. Li1 · Q. S. Zeng1 · X. P. Zhang1 Received: 22 August 2020 / Accepted: 29 September 2020 © Springer Nature Switzerland AG 2020
Complete mesenteric excision with central vascular ligation and dissection of lymph nodes at the origin of the supplying vessels has been used in curative resection of advanced colorectal cancer [1]. Since central lymph-node metastases are evidently correlated with the prognosis of patients, the extent of lymph-node dissection is one of the critical parts of radical surgery. High ligation of the inferior mesenteric artery (IMA), which is the supplying artery of the sigmoid colon and rectum, is advocated in that it allows for en bloc dissection of the nodes, improves lymph-node harvest, and enables accurate tumor staging and anastomosis without tension. Although perfusion of the proximal bowel limb is reduced, randomized-controlled studies showed that high ligation did not increase the risk of anastomotic leakage [2]. Thus, most surgeons from Asia recommend high ligation of the IMA. However, there is no universally accepted procedure of IMA high ligation. A study on radio-surgical agreement on the IMA ligation level indicated that surgeons correctly identified the IMA ligation level only in approximately twothirds of cases [3]. Moreover autonomic nerve preservation
during laparoscopic high ligation is time-consuming and challenging [4]. To achieve high quality lymph-node dissection without sacrificing autonomic nerves, we have explored a simple and effective procedure for laparoscopic high ligation of the IMA based on three anatomical levels as shown in the attached video. There were no major intra- or postoperative complications in any of the patients who had high ligation of IMA with nerve-sparing in our department. Our procedure allows both central lymph-node dissection, and preservation of the autonomic nerves without prolonged operation time, excessive complications, or bleeding. Integrity of the fascia enveloping the nerves maintained. The three anatomical levels and integrated neurofascial layer are illustrated in Fig. 1. The surgical operation which we propose consists in a stepwise approach, easy to learn, and could become a standard technique for performing high ligation of the IMA.
* X. P. Zhang [email protected] 1
Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300000, China
13
Vol.:(0123456789)
Techniques in Coloproctology
Fig. 1 a Three anatomical levels highlighted in different colors; the parietal fascia contains the aorta (red, A), the neurofascial layer contains the autonomic nerves (yellow, N), and the mesosigmoid colon
contains the vessels (purple, M). b Integrity of the neurofascial layer was maintained (the nerves are highlighted)
Funding This study was supported by Wu Jieping Medical Foundation (320.2710.1821) and Research Project of Tianjin Union
Data Loading...
