Yoshiaki Kita, Shinichiro Mori, Kenji Baba, Yasuto Uchikado, Takaaki Arigami, Yoshikazu Uenosono, Yuko Mataki, Masahiko Sakoda, Akihiro Nakajo, Kosei Maemura, Shoji Natsugoe. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine
Objective: We have been reported the clinical usefulness of intraoperative Doppler ultrasonographic guided vessel tracking during open operation (Pancreaticoduodenectomy) to identify critical arteries and veins in order to reduce operative bleeding (Maemura et al, INt Surg 2014). In this time following preview this report, we anticipate trial evaluating intraoperative Doppler ultrasonography (Dop-US) on laparoscopic left side colectomy preliminary.
Surgical procedure and Result: The patients were placed in the supine position. Five trocars were inserted in the abdomen as usual, maintaining pneumoperitoneum at 10 mmHg with carbon dioxide. A 10-mm flexible laparoscope was inserted from the umbilical port. We conducted ordinary operation above. When we stumble up the abnormal pattern of artery or vein before or during operation, bidirectional Dop-US blood flowmeter (ES-100V3; Hadeco, Kawasaki, Japan) were functioned trough trocar where side of dominant hand of the operator. This device is able to make sure the waveform of blood flow handy, easily and immediately. Moreover, we were able to realize each different vessel existence to evaluate the detail, for instance, wave shape, interval and velocity on this equipment. Actually, encountering the anomalous systemic drainage of ileocolic veins (called veins of Retzius) which wrap around superior mesenteric artery and flow into inferior vena cava, it was possible to detect and address first blanch of Sigmoid colon arter and some Rezius veinsy quickly. On the other hand, when we stumbled up superior mesenteric artery(IMA) from Abdominal Aneurism, enhanced CT found the complete obstruction of inside of IMA due to blood clot and calcification. Therefore, we intended to avoid to manipulate roots of IMA as much as possible after the conformation where the left colic artery (LCA) and superior rectal artery (SRA) are by Dop-US, after precise dissection, it was available to expose clip and cut down SRA right after branch off LCA safety.
Conclusion: Recently, Dop-US has been successfully used to obtain detailed blood flow images for various organs and organ systems such as the cardiovascular system, kidney, hepatobiliary-pancreatic system, and spleen. The imaging techniques used by surgeons to navigate these network of vessels and nerves are limited to preoperative imaging, which do not accommodate tissue displacement during the operation. Moreover, it is not available to touch pulsation directly on laparoscopic suregery. In case of preservation of LC, Intraoperative Dop-Navi method on laparoscopic left side colectomy allows surgeons to clearly identify the abnormality and to avoid injuries to major vessels.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80191
Program Number: P272
Presentation Session: Poster (Non CME)
Presentation Type: Poster
