Navigating anatomical complexity in laparoscopic sigmoid cancer surgery: A three-dimension reconstruction protocol for intraoperative safety and efficiency.

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.