Minimally Invasive Tailor-made Surgery for Colorectal Cancer Navigated by Integrated 3D-CT Imaging

Abstract

For advanced right colon cancer, we perform lymph node dissection exposing so called the surgical trunk. For theresection of advanced proximal sigmoid cancer, we sometimes perform lymph node dissection around root of IMA withpreserving the left colic artery and superior rectal artery. For either of these procedures performing safely, it is importantto know the precise individual vascular anatomy bearing their variations. However, there are major issues in laparoscopicsurgery, such as no tactile sensation, limitation on visual fields. To overcome these issues and to accurately identify thevascular anatomy of each patient, we have applied Integrated 3D-CT as preoperative simulation and intraopetative navigationsince July, 2000. Under the precise recognition of laparoscopic surgical anatomy, additionally simulated and navigatedby Integrated 3D-CT imaging for each patient, systematic lymphadenectomy with tailor-made vascular dissection bylaparoscopy appears to be feasible and more meticulous compared to one by conventional open surgery.