Anatomical controversies involved in radical resection of rectal cancer / 中华胃肠外科杂志

The concept of total mesorectal resection provides a quality control standard that can be followed for radical resection of rectal cancer, but some anatomical problems are still controversial. Compared with traditional open surgery, laparoscopic radical rectal surgery has better surgical vision, better neurological protection, better operating space. However, if the surgeon has insufficient understanding of the anatomy, collateral damage may occur, such as uncontrollable bleeding during the operation, postoperative urination and defecation dysfunction and so on. Based on the interpretation of the researches at home and abroad, combined with the clinical experience, we elucidate some associated issues, including anatomic variation of inferior mesenteric vessels, the controversy of inferior mesenteric artery ligation plane, the controversy of lymph node dissection in No. 253, the anatomical variation of middle rectal artery, and the anatomical controversy of lateral lymph node dissection in rectal cancer, in order to provide better cognitive process for the clinical front-line surgeons.

Morphological Study of Internal Iliac Artery.

Background: The internal iliac artery is the “artery of the pelvis”. It supplies most of the blood to the pelvic viscera, gluteal region, medial thigh region and perineum. A severe and potentially lethal complication in pelvic surgeries is arterial bleeding commonly involving the branches of internal iliac artery. While operating on pelvic organs, the knowledge of internal iliac artery and its variations is important for surgeons. The present study was conducted to study of morphology of internal iliac artery. Methods: 50 adult human pelvic halves were procured from embalmed cadavers of J.J.M. Medical College and S.S.I.M.S & R.C, Davangere, Karnataka, India for the study. Results: The classification of branching pattern of internal iliac artery was based on modified Adachi classification. Out of the 50 specimens studied, Type Ia arrangement was found in 52% of the specimens, Type III in 34%, Type IIa and type V was found in 2% each, Type IV was not found in any of the specimens and 10% of the specimens could not be classified because of the absence of inferior gluteal artery in them. Adachi Type Ia arrangement was the most frequent finding. The obturator artery took origin most frequently from the anterior division of internal iliac artery. Middle rectal artery was not constant. Conclusion: The internal iliac artery morphology shows multiple variation the knowledge is very helpful during pelvic surgeries.