Evaluation of the SYNAPSE VINCENT for lateral lymph node dissection in rectal cancer with robotic surgery: a preliminary report

Abstract

Background Even if 3D angiographic images of preoperative contrast-enhanced computed tomography (CT) are created, the coronal and axial sections can be unclear, and thus, it is difficult to achieve projection awareness similar to that of actual laparoscopic images. In recent years, the technology of analyzing and applying medical images has advanced, and surgical simulation and navigation have been widely used to improve the safety of surgical operations. It is important to understand pelvic anatomy in the area of rectal cancer, and use of the SYNAPSE VINCENT makes it possible to simulate the anatomy before surgery, which is very useful in educating surgeons and their assistants. Materials and methods An important objective in surgery is to understand the anatomy of the external/internal iliac arteries and lymph nodes in lateral lymph node dissection (LLD) for rectal cancer. In this study, we explored the accuracy and usefulness of SYNAPSE VINCENT images of pelvic anatomy (especially vascular anatomy) analyzed preoperatively in two cases of LLD for rectal cancer in our department. Results The patients were two men aged 73 and 57 years, respectively. Both patients underwent robotic abdominal perineal resection and LLD with neoadjuvant chemoradiotherapy. The operating times for LLD were 138 and 106 min, estimated blood loss was less than 10 mL and 20 mL, and the harvested lymph nodes were nos. 21 and 22, respectively. The SYNAPSE VINCENT could be used for simulation and navigation before and during surgery. For experienced surgeons, the system helped them carry out operations more accurately. Conclusion In the future, surgical support using virtual reality, augmented reality, and mixed reality based on medical images will be useful and is expected to improve the safety, accuracy, and efficiency of surgery, which is extremely useful for both young and skilled surgeons preparing for difficult operations.

Right top pulmonary vein is a venous anomaly of which surgeons should be aware in subcarinal dissection for thoracoscopic esophagectomy: a case report and literature review

“…It is important to recognize the presence of the RTPV preoperatively because DB may lead to difficulty during differential lung ventilation and can lead to bronchial and vascular injury [19]. Preoperative simulation and intraoperative navigation with 3D images, which can be freely rotated and interactively visualized from any angle, are useful methods to enhance the surgeon's understanding of the anatomy [20][21][22]. The use of 3D imaging enabled the preoperative diagnosis of three cases, including the present case.…”

Sonographically-guided Parasacrum Infrapiriformis Drainage of Deep Pelvic Abscesses: An Anatomical Safety Study Using SYNAPSE VINCENT

“…Regarding nerve and vessel injury, placement of a catheter upward near the piriform muscle or sacral plexus increases the incidence of pelvic and leg pain, so whenever possible, the catheter route should pass below the foramen through the sacrospinous ligament or below it[ 1 , 5 , 11 ]. Walser et al[ 8 ] performed transgluteal ultrasonography via a parasacral approach. The advantages of ultrasound include a short time in the CT imaging area, short procedure time, low radiation exposure, and real-time color Doppler imaging (CDI) during needle placement to avoid vascular puncture.…”

“…The patient was administered local anesthesia only, and the fluid pool was punctured under continuous ultrasound guidance. The sacrum or coccyx was palpated as a landmark, and the puncture site was kept as close to this landmark on the caudal side as possible to avoid injury to the neurovascular bundle and piriform muscle[ 8 ]. After aspirating the fluid, a guidewire was placed and an 8-French pigtail catheter was advanced into the fluid collection using the Seldinger technique.…”

“…SYNAPSE VINCENT (Fujifilm Medical Co., Ltd., Tokyo, Japan) analyzes medical images in 3D by applying image recognition technology used for face recognition in digital cameras. The system is frequently used for surgical support, especially in the hepatobiliary and pancreatic regions[ 8 ]. This study aimed to evaluate the anatomy of the pelvic cavity, focusing on the route of transgluteal drainage, using a 3D image analysis system (SYNAPSE VINCENT).…”