Nihon Geka Gakkai zasshi最新文献

In the last five years, many hospitals in Japan have created three-dimensional (3D) images from computed tomography (CT) data from patients who have undergone liver resection to share the images of liver structures with the surgical team and analyze the liver volume based on portal perfusion. However, using the previous software packages, the 3D liver model was fixed and rigid. Therefore, we developed novel 3D simulation software, called Liversim, to visualize real-time malformations of the liver. There were no marked differences during the process of liver resection between Liversim and actual surgery. Virtual liver resection showing real-time malformations of the liver using Liversim is useful for the safe performance of liver resections.

Because of its low invasiveness, endovascular aneurysmal repair was established as a new method of treatment for aortic aneurysms, revolutionizing the treatment of this condition. With the continuing development of technology and devices, endovascular aneurysmal repair has become safer than before. Innovations in imaging support systems including navigation systems have contributed greatly to the development of endovascular procedures, making transcatheter aortic valve implantation a safe surgical option. We discuss such innovations and the future development of imaging support systems for safe cardiovascular surgery.

For advanced right colon cancer, we perform lymph node dissection exposing the so-called surgical trunk. For the resection of advanced distal sigmoid/rectal cancer, we routinely perform lymph node dissection around the root of the inferior mesenteric artery, preserving the left colic artery. To perform either of these procedures safely, it is important to know the precise vascular anatomy with individual variations. However, there are major issues in laparoscopic surgery, such as a lack of tactile sensation and limited visual field. To overcome these issues and identify the vascular anatomy of each patient accurately, we have applied integrated three-dimensional computed tomography (3D-CT) imaging as a preoperative simulation and for intraoperative navigation since July 2000. Integrated 3D-CT imaging appears to be useful, especially for cancer located around the left flexure of the transverse colon, where major variations in vascular anatomy occur. Using the no-touch technique appropriately with the precise determination of laparoscopic surgical anatomy based on simulation and navigation by integrated 3D-CT imaging for each patient, systematic lymphadenectomy in addition to lateral lymph node dissection with tailor-made vascular laparoscopic dissection for the treatment of advanced lower rectal cancer appears to be feasible and a more meticulous approach compared with conventional open surgery.

Preoperative simulation of vascular anatomy has been widely accepted in order to reduce surgical complications and improve postoperative outcomes. In esophagectomy, preservation of the bronchial artery (BA) was shown to reduce postoperative pulmonary complications. However, some anomalous BA branching patterns have been reported and these can make BA preservation difficult during surgery. Recently, the clinical utility of preoperative three-dimensional computed tomography angiography (3D-CTA) has been reported as a form of preoperative anatomical simulation. Consequently, the BA was safely preserved and efficient lymph node (LN) dissection was achieved. In surgery for gastric cancer, tracing the inner dissectable layer is necessary for LN dissection. Particularly in laparoscopic total gastrectomy with spleen preservation, there is considerable variation in the vascular anatomy of the splenic artery, splenic vein, and short gastric artery. Therefore, preoperative 3D-CTA could improve the safety of this procedure. Recently, the number of dissected LNs has been shown to be increased after introduction of 3D-CTA in laparoscopic surgery for both esophageal and gastric cancer, which showed that preoperative anatomical simulation could achieve more radical LN dissection. As a future perspective, intraoperative navigation systems could become more practical guides for endoscopic surgery for upper gastrointestinal cancer.