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Umberto BRACALE

University Federico II
Naples, Italy
MD
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Vascular anatomy of left and right colon: standard vs. variations
The vascular anatomy of the colon has some anatomical variations [1]. In this video, starting from the normal surgical anatomy of the colon, authors show many vascular anomalies of surgical interest, which should be known in order to avoid intraoperative complications. In the right colon, the ileocolic artery and the middle colic artery are constantly present in all patients as they arise from the superior mesenteric vessels [2]. Right colic vessels are present only in 80% of cases. The position of ileocolic vessels related to the superior mesenteric vein (SMV) is a key landmark. In this video, starting from the normal surgical anatomy of the right colon, authors show variant ileocolic vessels position defined type A pattern, with ileocolic artery (ICA) which lies in the anterior position in respect to the ileocolic vein (ICV). Authors also show an anomalous origin of the ileocolic vessels, which are more upper in respect to their standard position. Commonly, the ileocolic artery (ICA) lies posterior to the SMV (83%, type B). However, the ICA sometimes lies anteriorly to the SMV (17%, type A) [1]. The vascular system of the left colon has fewer variations in terms of position and origin, contrarily to the right colon. The most frequent variations of the inferior mesenteric artery (IMA) supply involve the division of the sigmoid arteries, as classified by Latarjet in two different types, depending on the anatomical relationship between the left colic and sigmoid arteries [3]. However, in this video authors show a rare case of IMA arising from the superior mesenteric artery [4].
References:
1. Milsom JW, Böhm B, Nakajima K. Laparoscopic Colorectal Surgery 2006, Springer.
2. Wu C, Ye K, Wu Y, Chen Q, Xu J, Lin J, Kang W. Variations in right colic vascular anatomy observed during laparoscopic right colectomy. World J Surg Oncol 2019;17:16.
3. Patroni A, Bonnet S, Bourillon C, Bruzzi M, Zinzindohoue F, Chevallier JM, Douard R, Berger A. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat 2016;38:477-84.
4. Yoo SJ, Ku MJ, Cho SS, Yoon SP. A case of the inferior mesenteric artery arising from the superior mesenteric artery in a Korean woman. J Korean Med Sci 2011;26:1382-5.
Surgical intervention
13 days ago
635 views
10 likes
0 comments
21:44
Vascular anatomy of left and right colon: standard vs. variations
The vascular anatomy of the colon has some anatomical variations [1]. In this video, starting from the normal surgical anatomy of the colon, authors show many vascular anomalies of surgical interest, which should be known in order to avoid intraoperative complications. In the right colon, the ileocolic artery and the middle colic artery are constantly present in all patients as they arise from the superior mesenteric vessels [2]. Right colic vessels are present only in 80% of cases. The position of ileocolic vessels related to the superior mesenteric vein (SMV) is a key landmark. In this video, starting from the normal surgical anatomy of the right colon, authors show variant ileocolic vessels position defined type A pattern, with ileocolic artery (ICA) which lies in the anterior position in respect to the ileocolic vein (ICV). Authors also show an anomalous origin of the ileocolic vessels, which are more upper in respect to their standard position. Commonly, the ileocolic artery (ICA) lies posterior to the SMV (83%, type B). However, the ICA sometimes lies anteriorly to the SMV (17%, type A) [1]. The vascular system of the left colon has fewer variations in terms of position and origin, contrarily to the right colon. The most frequent variations of the inferior mesenteric artery (IMA) supply involve the division of the sigmoid arteries, as classified by Latarjet in two different types, depending on the anatomical relationship between the left colic and sigmoid arteries [3]. However, in this video authors show a rare case of IMA arising from the superior mesenteric artery [4].
References:
1. Milsom JW, Böhm B, Nakajima K. Laparoscopic Colorectal Surgery 2006, Springer.
2. Wu C, Ye K, Wu Y, Chen Q, Xu J, Lin J, Kang W. Variations in right colic vascular anatomy observed during laparoscopic right colectomy. World J Surg Oncol 2019;17:16.
3. Patroni A, Bonnet S, Bourillon C, Bruzzi M, Zinzindohoue F, Chevallier JM, Douard R, Berger A. Technical difficulties of left colic artery preservation during left colectomy for colon cancer. Surg Radiol Anat 2016;38:477-84.
4. Yoo SJ, Ku MJ, Cho SS, Yoon SP. A case of the inferior mesenteric artery arising from the superior mesenteric artery in a Korean woman. J Korean Med Sci 2011;26:1382-5.
Redo laparoscopic anterior resection
The reported incidence rates of regional recurrence for colorectal cancer after oncologic resection ranged between 5% and 19%. Locoregional recurrence occurs in the anastomotic site, the remnant colon, the peritoneal surface (nodal or soft tissue), or the retroperitoneum. As reported in the literature, in colorectal cancers, mucinous differentiation, lymphovascular invasion and anastomotic leakage are independent risk factors for anastomotic recurrence.
We present the case of an 86 year-old female patient. In 2014, the patient underwent a laparoscopic left colectomy for a Haggitt level 4 sigmoid polyp. The definitive histologic features showed a T2N0M0 mucinous adenocarcinoma. During the postoperative follow-up, 46 months after the left colectomy, an anastomotic recurrence was found. The patient underwent a laparoscopic colorectal resection for anastomotic recurrence. The operative time was 220 minutes. The patient was discharged on postoperative day 6. No complications occurred intraoperatively and postoperatively.
References:
1. Gopalan S, Bose JC, Periasamy S (2015) Anastomotic Recurrence of Colon Cancer-is it a Local Recurrence, a Second Primary, or a Metastatic Disease (Local Manifestation of Systemic Disease)? Indian J Surg 77:232-236.
2. Ramphal W, Boeding JRE, Gobardhan PD, Rutten HJT, de Winter L, Crolla R, Schreinemakers JMJ (2018) Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol 27:730-736.
3. Jung WB, Yu CS, Lim SB, Park IJ, Yoon YS, Kim JC (2017) Anastomotic Recurrence After Curative Resection for Colorectal Cancer. World J Surg 41:285-294.
Surgical intervention
4 months ago
2815 views
3 likes
1 comment
23:20
Redo laparoscopic anterior resection
The reported incidence rates of regional recurrence for colorectal cancer after oncologic resection ranged between 5% and 19%. Locoregional recurrence occurs in the anastomotic site, the remnant colon, the peritoneal surface (nodal or soft tissue), or the retroperitoneum. As reported in the literature, in colorectal cancers, mucinous differentiation, lymphovascular invasion and anastomotic leakage are independent risk factors for anastomotic recurrence.
We present the case of an 86 year-old female patient. In 2014, the patient underwent a laparoscopic left colectomy for a Haggitt level 4 sigmoid polyp. The definitive histologic features showed a T2N0M0 mucinous adenocarcinoma. During the postoperative follow-up, 46 months after the left colectomy, an anastomotic recurrence was found. The patient underwent a laparoscopic colorectal resection for anastomotic recurrence. The operative time was 220 minutes. The patient was discharged on postoperative day 6. No complications occurred intraoperatively and postoperatively.
References:
1. Gopalan S, Bose JC, Periasamy S (2015) Anastomotic Recurrence of Colon Cancer-is it a Local Recurrence, a Second Primary, or a Metastatic Disease (Local Manifestation of Systemic Disease)? Indian J Surg 77:232-236.
2. Ramphal W, Boeding JRE, Gobardhan PD, Rutten HJT, de Winter L, Crolla R, Schreinemakers JMJ (2018) Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol 27:730-736.
3. Jung WB, Yu CS, Lim SB, Park IJ, Yoon YS, Kim JC (2017) Anastomotic Recurrence After Curative Resection for Colorectal Cancer. World J Surg 41:285-294.
Totally laparoscopic total gastrectomy for stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma
A 66-year-old man was admitted to our hospital with complaints of epigastric pain. His hemoglobin level was 9.3g/dL. Endoscopy of the upper gastrointestinal tract (EGD) showed an advanced gastric carcinoma that had invaded the middle and lower third of the stomach. A biopsy specimen revealed a moderately differentiated adenocarcinoma. Abdominal computed tomography (CT) showed that the tumor had invaded the stomach wall. Enlarged lymph nodes were present only around the lesser curvature (regional lymph nodes No. 3). The patient was diagnosed with stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma1. The patient was then taken to the operating room for exploratory laparoscopy and laparoscopic total gastrectomy with D2 lymphadenectomy. The operation time was 260 minutes. No further evidence of intra-abdominal disease or liver involvement was noted. The patient did well postoperatively and was subsequently discharged home on postoperative day 9. Four metastatic lymph nodes/twenty eight regional lymph nodes were found; so the pathological findings confirmed stage IIIA. The patient is disease-free at 10 months. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.
Surgical intervention
9 years ago
5402 views
34 likes
0 comments
26:02
Totally laparoscopic total gastrectomy for stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma
A 66-year-old man was admitted to our hospital with complaints of epigastric pain. His hemoglobin level was 9.3g/dL. Endoscopy of the upper gastrointestinal tract (EGD) showed an advanced gastric carcinoma that had invaded the middle and lower third of the stomach. A biopsy specimen revealed a moderately differentiated adenocarcinoma. Abdominal computed tomography (CT) showed that the tumor had invaded the stomach wall. Enlarged lymph nodes were present only around the lesser curvature (regional lymph nodes No. 3). The patient was diagnosed with stage IIIA (cT3 cN1 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma1. The patient was then taken to the operating room for exploratory laparoscopy and laparoscopic total gastrectomy with D2 lymphadenectomy. The operation time was 260 minutes. No further evidence of intra-abdominal disease or liver involvement was noted. The patient did well postoperatively and was subsequently discharged home on postoperative day 9. Four metastatic lymph nodes/twenty eight regional lymph nodes were found; so the pathological findings confirmed stage IIIA. The patient is disease-free at 10 months. Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.
Totally laparoscopic subtotal gastrectomy with D2 lymphadenectomy for stage II (cT3 cN0 cM0) advanced gastric carcinoma
A 54-year-old female patient with a past medical history of hypertension presented with abdominal pain and an episode of coffee ground emesis. Symptoms of pain and vomiting started approximately two to three months before admission and began to worsen over the past month. The pain was relieved by food. The patient also admitted to unspecified weight loss over the same period of time. On physical examination, mild distension of the abdomen was observed with a mild to moderate tenderness to palpation involving epigastric tenderness. An endoscopy of the upper gastrointestinal tract (EGD) revealed a gastric ulcer extending to the lower part of the stomach. No active bleeding was observed at the site. Gastric outlet obstruction was also noted with an inflamed edematous pylorus. Biopsy revealed a moderately differentiated gastric carcinoma. Staging CT-scan imaging studies revealed no sites of metastasis. The patient was diagnosed with stage II (cT3 cN0 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma. The patient was then taken to the operating room for laparoscopic subtotal gastrectomy with D2 lymphadenectomy. The operation time was 220 minutes. No further evidence of intra-abdominal disease or liver involvement was observed. The patient did well postoperatively and was subsequently discharged home on postoperative day 7. No metastatic lymph nodes / twenty-two regional lymph nodes were found; so the pathological findings confirmed stage II. The patient is disease-free at 12 months.
Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.
Surgical intervention
9 years ago
6745 views
73 likes
0 comments
25:53
Totally laparoscopic subtotal gastrectomy with D2 lymphadenectomy for stage II (cT3 cN0 cM0) advanced gastric carcinoma
A 54-year-old female patient with a past medical history of hypertension presented with abdominal pain and an episode of coffee ground emesis. Symptoms of pain and vomiting started approximately two to three months before admission and began to worsen over the past month. The pain was relieved by food. The patient also admitted to unspecified weight loss over the same period of time. On physical examination, mild distension of the abdomen was observed with a mild to moderate tenderness to palpation involving epigastric tenderness. An endoscopy of the upper gastrointestinal tract (EGD) revealed a gastric ulcer extending to the lower part of the stomach. No active bleeding was observed at the site. Gastric outlet obstruction was also noted with an inflamed edematous pylorus. Biopsy revealed a moderately differentiated gastric carcinoma. Staging CT-scan imaging studies revealed no sites of metastasis. The patient was diagnosed with stage II (cT3 cN0 cM0) advanced gastric carcinoma according to the Japanese classification of gastric carcinoma. The patient was then taken to the operating room for laparoscopic subtotal gastrectomy with D2 lymphadenectomy. The operation time was 220 minutes. No further evidence of intra-abdominal disease or liver involvement was observed. The patient did well postoperatively and was subsequently discharged home on postoperative day 7. No metastatic lymph nodes / twenty-two regional lymph nodes were found; so the pathological findings confirmed stage II. The patient is disease-free at 12 months.
Japanese Classification of Gastric Carcinoma - 2nd English Edition. Gastric Cancer 1998;1:10-24.