Virtual CT gastrectomy by three-dimensional imaging using multidetector-row CT for laparoscopic gastrectomy

Key words: Virtual computed tomographic gastrec-tomy—Multidetector row computed tomogra-phy—Three-dimensional imaging—Multiphase fusionimaging—LaparoscopicgastrectomyLaparoscopicsurgeryhasgainedwideclinicalacceptancein various surgical practices and has become the goldstandard for cholecystectomy, Nissen fundoplication,and adrenal surgery. In 1994, the first laparoscopicallyassisted Billroth I gastrectomy was reported, and cur-rently a laparoscopic distal gastrectomy is commonlyperformedforearlystagegastriccancer[1].Thebenefitsof the laparoscopic approach include smaller surgicalincisions, less intraoperative blood loss, faster recoveryfor normal bowel function, and shorter hospital staysthaninthecaseofconventionalopensurgery[1–4].However, despite the advantages of this procedure,thereremainseveraldisadvantages:limitedimagesoftheentire operative field under laparoscopy and a lack oftactilesensationinterferewithdirectmanipulationbythesurgeonduringtheprocedure.Forthisreason,ittakesalongtimetoidentifythepropervesselswheretheremaybe major variations in each patient [2]. Moreover,arteriesrunalongoracrossveinsaroundthestomachina complicated fashion; therefore, veins can be injuredduring the dissection of lymph nodes along the arteriesandtheligationofarteriesunderlaparoscopicguidance,whichleadstoheavybleedingthatpreventsthesurgeonfromhavingaccesstoagoodviewoftheoperativefield[3].Therefore,itisquiteimportanttoperformapreop-erative assessment of vascular anatomy around thestomach using three-dimensional (3D) computed tomo-graphic(CT)angiography,whichcanbeveryhelpfultoachieve the safe and rapid ligation of vessels and dis-sectionoflymphnodes[5–9].We performed contrast-enhanced examinations atarterial and venous phase using 4 or 16 multidetector-rowCT(MDCT)beforealaparoscopicgastrectomyandslicedatafromtheindividualphaseswereconvertedintoa 3D imaging format using a volume-rendering tech-nique.Weusedthefusedimageof3Dimagesofarteriesand veins around the stomach for preoperative assess-ment and called the use of 3D imaging virtual CT gas-trectomy[5–9].In this study, we examined the usefulness of virtualCT gastrectomy for laparoscopic gastrectomy and,moreover, introduced our preliminary study of the vir-tualCTnavigationofsentinellymphnodes.