Comparison and impact of preoperative 3D virtual vascular modelling with intraoperative indocyanine green perfusion angiography for personalized proximal colon cancer surgery.

Abstract

3D virtual modelling (3DVM) of mesenteric vasculature and indocyanine green perfusion angiography (ICGPA) should correlate for the purposes of better preoperative planning and intraoperative performance during laparoscopic right hemicolectomy with complete mesocolic excision (CME) and central vascular ligation (CVL) for proximal colon cancer. We studied this, and their combined impact on surgical decision making, in a cohort of 20 such patients undergoing CT mesenteric angiography and 3DVM prior to surgery with the surgical team utilizing these technologies for operative planning. ICGPA was employed intraoperatively in every case to assess the perfusion of the planned anastomotic site. Preoperative planning with 3DVM correlated highly with intraoperative findings including major vessel presence (95 %) and ICGPA signalling (100 %) with no postoperative anastomotic complications observed. The analysis highlights how personalized, 3D virtual vascular maps can contribute to decisions on surgical resection extent and anastomotic site, ensuring adequate perfusion for healing and optimizing patient outcomes.