The Role of Anatomical Dissection in Defining Colic and Small Bowel Artery Lymphovascular Bundles in the D3 Volume of Small and Large Bowel Mesentery.

The D3 lymphadenectomy with extended mesenteric/mesocolic excision is becoming a standard in the surgery of small and large bowel carcinoma. The aim of this study is to present the feasibility of macro- and microdissection of the mesenteric lymphatics in the root of the mesentery with accompanying morphometry of the lymphatic clearances. The study was carried out on three embalmed cadavers from the body donor program.

Lymphatic and vascular anatomy define surgical principles for radical treatment of distal duodenal and proximal jejunal tumors.

Background: The arterial ligation level and the lymphadenectomy extent for surgical treatment of distal duodenal/proximal jejunal tumors are not standardized.

Aim: To define morphometric and topographic specifics of the superior jejunal artery (SJA) and the superior jejunal vein (SJV), and the width of arterial lymphovascular bundles through lymphatic clearances. By extrapolating results from two methodologies, the goal is to determine the arterial ligation level and the lymphadenectomy extent for duodenojejunal tumor treatment.

Lymphatic and vascular anatomy define surgical principles for bowel-sparing radical treatment of ileal tumors.

Background: There is no consensus on the level of vascular ligation and the extent of lymphadenectomy in the treatment of ileal tumors. This study aims to define lymphovascular bundles of the terminal ileal artery (TIA) and subsequent ileal arteries. It also aims to extrapolate results from two distinct methodologies to define the level of arterial ligation and the dissection area for radical and bowel-sparing surgery.

Jejunal Lymphatic and Vascular Anatomy Defines Surgical Principles for Treatment of Jejunal Tumors.

Background: The jejunum has a wide lymphatic drainage field, making radical surgery difficult.

Objective: Extrapolate results from 2 methodologies to define jejunal artery lymphatic clearances and lymphovascular bundle shapes for radical bowel-sparing surgery.

Design: Two cohort studies.

Retrocolic Fascia-An Anatomical and Multidetector Computed Tomographic Angiography (MDCTA) Morphometric Analysis in Patients with Right Colon Cancer.

Background: This study aims to delineate anatomical landmarks crucial for complete mesocolic excision, focusing on Gerota's fascia, which guides surgical dissection in right-sided colon cancer, forming the posterior limit. Employing a multimodal approach, the research aims to understand the fascial anatomy and its variations under pathological conditions.

Methods: Three methods were applied: a pilot dissection on an embalmed cadaver for clear anatomical presentation of prerenal fascia, Mimics segmentation of the fascia and its relationship with the colon, and a retrospective analysis of MDCTA scans from 196 patients (mean age 65.

Are Metastatic Central Lymph Nodes (D3 volume) in right-sided Colon Cancer a Sign of Systemic Disease? A sub-group Analysis of an Ongoing Multicenter Trial.

Objective: Assess outcomes of patients with right-sided colon cancer with metastases in the D3 volume after personalized surgery.

Background: Patients with central lymph node metastasis (D3-PNG) are considered to have a systemic disease with a poor prognosis. A 3-dimensional definition of the dissection volume allows the removal of all central nodes.

Visible Lymph Affluents in the D3 Volume: An MDCTA Pictorial Essay.

Background: There seems to be a gap in knowledge of the anatomy of mesenteric lymphatics between the superior mesenteric nodes and the intestinal trunk. To our knowledge, these central lymph vessels were not hitherto systematically searched for, described, or morphometrically analyzed. Our aim was to identify those vessels on the routine multidetector computerized tomography angiography (MDCTA), performed prior to right colectomy for cancer, with extended mesenterectomy, central vascular ligation, and D3 lymphadenectomy.

Establishing correlations between normal pancreatic and submandibular gland ducts.

Background: The objectives of this study were to evaluate the relationship between ductal morphometry and ramification patterns in the submandibular gland and pancreas in order to validate their common fractal dimension.

Methods: X-ray ductography with software-aided morphometry were obtained by injecting barium sulphate in the ducts of post-mortem submandibular gland and pancreas specimens harvested from 42 adult individuals.

Results: Three cases were excluded from the study because of underlying pathology.

Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models, part II: anatomy of relevance to surgeons operating splenic flexure cancer.

Background: The splenic flexure is irrigated from two vascular areas, both from the middle colic and the left colic artery. The challenge for the surgeon is to connect these two vascular areas in an oncological safe procedure.

Materials And Methods: The vascular anatomy, manually 3D reconstructed from 32 preoperative high-resolution CT datasets using Osirix MD, Mimics Medical and 3-matic Medical Datasets, were exported as STL-files, video clips, stills and supplemented with 3D printed models.

Reconstructing topography and extent of injury to the superior mesenteric artery plexus in right colectomy with extended D3 mesenterectomy: a composite multimodal 3-dimensional analysis.

Background: Superior mesenteric artery plexus (SMAP) injury is reported to cause postoperative intractable diarrhea after pancreatic/colonic surgery with extended lymphadenectomy. This study aims to describe the SMAP microanatomy and extent of injury after right colectomy with extended D3 mesenterectomy for cancer.

Methods: Three groups (I) anatomical dissection, (II) postmortem histology, and (III) surgical specimen histology were included.

Stool dynamics after extrinsic nerve injury during right colectomy with extended D3-mesenterectomy.

Introduction: To improve oncological outcome in right colon cancer surgery, an extended mesenterectomy (D3) is under evaluation. In this procedure, all tissue anterior and posterior to the superior mesenteric vessels from the middle colic to ileocolic artery origin is removed, causing injury to the superior mesenteric nerve plexus. The aim was to study the effects of this injury on bowel dynamics and quality of life (QoL).

Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer.

Background: The impact of the position of the middle colic artery (MCA) bifurcation and the trajectory of the accessory MCA (aMCA) on adequate lymphadenectomy when operating colon cancer have as of yet not been described and/or analysed in the literature. The aim of this study was to determine the MCA bifurcation position to anatomical landmarks and to assess the trajectory of aMCA.

Methods: The colonic vascular anatomy was manually reconstructed in 3D from high-resolution CT datasets using Osirix MD and 3-matic Medical and analysed.

Value of the surgeon's sightline on hologram registration and targeting in mixed reality.

Purpose: Mixed reality (MR) is being evaluated as a visual tool for surgical navigation. Current literature presents unclear results on intraoperative accuracy using the Microsoft HoloLens 1. This study aims to assess the impact of the surgeon's sightline in an inside-out marker-based MR navigation system for open surgery.

Preventing chylous ascites after right hemicolectomy with D3 extended mesenterectomy.

Background: We aim to find the incidence of chylous ascites in patients undergoing D3 extended mesenterectomy and evaluate if a routine fat-reduced diet (FRD) has a prophylactic effect.

Methods: Data from 138 patients included in a D3 extended mesenterectomy trial were collected prospectively. Surgical drains and biochemical testing of drain fluid were used to find the incidence of chylous ascites among the first 39 patients, and a prophylactic fat-reduced diet was then implemented in the next 99 patients as a prophylactic measure.

Semi-automated vs. manual 3D reconstruction of central mesenteric vascular models: the surgeon's verdict.

Background: 3D vascular anatomy roadmaps are currently being implemented for surgical planning and navigation. Quality of the reconstruction is critical. The aim of this article is to compare anatomical completeness of models produced by manual and semi-automatic segmentation.