Investigation of virtual vascular model in laparoscopic right hemicolectomy with complete mesocolic excision

Introduction and objective: Laparoscopic complete mesocolic excision (CME) with central vascular ligation is gaining acceptance for the treatment of right colon cancers, however, variable mesenteric vascular anatomy can be a surgical challenge, thus affecting results. The aim of our study is to investigate the usefulness of a 3D virtual vascular model reconstructed from CT-angiography. In this article, we demonstrate the application of 3D technology in a surgical area difficult to comprehend with conventional techniques.Method: In this randomized, controlled trial, we plan to enroll 40 patients with AJCC stage I-III right colonic cancer scheduled for laparoscopic CME surgery. Patients are randomized preoperatively one-to-one. The experimental group (A) has a 3D virtual vascular model created for pre-and intraoperative use, the control group (B) has no model available. Demographics, blood loss, vascular injuries, procedure duration, lymph node harvest, specimen quality, postoperative complications and length of stay are recorded. Surgeons rate the model postoperatively on a 0-10 scale. Long term oncologic outcomes will be recorded.Results: At submission of the abstract, 29 patients were enrolled (A = 18, B = 11). Demographics in the two groups are comparable. Blood loss (p = 0.40), conversion rate (p = 0.75), postoperative complications (p = 0.82) and hospital stay (p = 0.40) do not show significant difference, while lymph node yield (p = 0.76) and specimen quality are also comparable. Duration of standard surgical steps of central vascular ligation are comparable. Surgeons rate the overall usefulness of the 3D model 7.6/10, with the highest scores given for identifying ileocolic vessels (7.8) and Henle's trunk (8.3). The model was rated less useful for assisting gastroepiploic dissection (5.2). No patient dropout occurred to this date.Conclusion: Surgeons appraise the quality and usefulness of the model positively, especially for identifying ileocolic vessels and the anatomy of Henle's trunk.