Navigating anatomical complexity in laparoscopic sigmoid cancer surgery: A three-dimension reconstruction protocol for intraoperative safety and efficiency.
Zong-Xian Zhao, Run-Dong Yao, Zong-Ju Hu, Chao-Qian Chen, Shu Zhu, Yuan Yao
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Abstract
Background: Sigmoid colon cancer faces challenges due to anatomical diversity, including variable inferior mesenteric artery (IMA) branching and tumor localization complexities, which increase intraoperative risks.
Aim: To comprehensively evaluate the impact of three-dimensional (3D) visualization technology on enhancing surgical precision and safety, as well as optimizing perioperative outcomes in laparoscopic sigmoid cancer resection.
Methods: A prospective cohort of 106 patients (January 2023 to December 2024) undergoing laparoscopic sigmoid cancer resection was divided into the 3D (n = 55) group and the control (n = 51) group. The 3D group underwent preoperative enhanced computed tomography reconstruction (3D Slicer 5.2.2 & Mimics 19.0). 3D reconstruction visualization navigation intraoperatively guided the following key steps: Tumor location, Toldt's space dissection, IMA ligation level selection, regional lymph node dissection, and marginal artery preservation. Outcomes included operative parameters, lymph node yield, and recovery metrics.
Results: The 3D group demonstrated a significantly shorter operative time (172.91 ± 20.69 minutes vs 190.29 ± 32.29 minutes; P = 0.002), reduced blood loss (31.5 ± 11.8 mL vs 44.1 ± 23.4 mL, P = 0.001), earlier postoperative flatus (2.23 ± 0.54 days vs 2.53 ± 0.61 days; P = 0.013), shorter hospital length of stay (13.47 ± 1.74 days vs 16.20 ± 7.71 days; P = 0.013), shorter postoperative length of stay (8.6 ± 2.6 days vs 10.5 ± 4.9 days; P = 0.014), and earlier postoperative exhaust time (2.23 ± 0.54 days vs 2.53 ± 0.61 days; P = 0.013). Furthermore, the 3D group exhibited a higher mean number of lymph nodes harvested (16.91 ± 5.74 vs 14.45 ± 5.66; P = 0.030).
Conclusion: The 3D visualization technology effectively addresses sigmoid colon anatomical complexity through surgical navigation, improving procedural safety and efficiency.
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