Usefulness of Laparoscopic Color Doppler Sonography in Identifying Vascular Structures During Laparoscopic Operation of Colorectal Cancer

Introduction: In proctectomy for rectal cancer, to identify the vascularities of the intestine, structures of inferior mesenteric artery (IMA), left colic artery (LCA) and sigmoid artery (SA), it is important to perform safe and curative operations. However, it is difficult to know laparosocopically, where the point of LCA branching off from IMA is and whether SA branches off from either the IMA or LCA. A laparoscopic color Doppler sonography (LCDS) was employed to identify the variation of vascularity during laparoscopic proctectomy.
Methods: LCDS (PEF-704 LA; TOSHIBA MEDICAL CO.) was used in this study. The procedure using LCDS was performed in eight cases of laparoscopic proctectomy.
Results: The sensor of LCDS was applied to the back sides of the vessels. In seven cases out of eight (87.5%), the points at which LCA branches off from IMA were identified. IMA and LCA revealed opposite colors, red and blue, on LCDS. SAs were difficult to detect on LCDS due to little blood flow. Mean survey time was 8 minutes.
Conclusions: Preoperative 3D-CT angiography is the standard method for detection of variation of vascularity, but requires contrast media. Using LCDS, we can identify the variation of the vascularity in real time without contrast media.