In the first part of the transcript, the speaker introduces their research on the vascular anatomy of the splenic flexure, an important area in colorectal cancer surgery. They mention their current role as a global surgeon working for the Red Cross movement and the Tesla Foundation Norway, where they treat trauma and weapon-wounded patients while also being involved in colorectal cancer surgery in Ethiopia and Rwanda.
The main focus of their research is to improve understanding of the blood supply to the splenic flexure, which is critical for both colon cancer surgeries and the prevention of complications.
The speaker explains that the colon is divided into several sections, and the splenic flexure is particularly significant because it is where the blood supply from two major arteries— the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA)—meet.
They emphasize that modern surgery is increasingly focusing on the embryological development of the digestive system, as it has implications for how cancer surgeries are conducted. The speaker illustrates how understanding the vascular anatomy, particularly the blood vessels and lymphatic systems, is essential for preventing bleeding and ensuring adequate blood flow during surgeries like colon cancer resections.
A key element of the discussion is the relationship between the middle colic artery, a branch of the SMA, and the left colic artery, a branch of the IMA, in supplying the splenic flexure. The speaker also introduces the lymphatic system, explaining how cancer can spread through lymphatic vessels along these arterial routes. This makes understanding the exact vascular anatomy critical for effective cancer management. Lymph node dissection, particularly the removal of intermediate and central lymph nodes, is discussed as part of the surgical procedures for cancer removal.
The speaker highlights the differences between Japanese and European techniques for lymph node dissection, including D1, D2, and D3 dissections, noting that the optimal procedure depends on the precise anatomy of the arteries and lymph nodes.
The research team used advanced techniques such as CT scans, 3D reconstructions, and 3D printed vascular models to study the complex anatomy of the splenic flexure. The speaker highlights the variations found in patients’ vascular systems, such as the unusual positioning of the middle colic artery or the presence of an accessory middle colic artery, which could complicate surgery and increase the risk of cancer spreading through the lymphatic system.
Finally, the speaker discusses the challenges posed by the three-dimensional relationship between the middle colic artery and the inferior mesenteric artery, coining the term “mesenteric inter-arterial stair” to describe this spatial relationship. This relationship is important for understanding how to safely connect the two vascular areas during oncological surgery. The speaker also covers the complexity of accessing the inferior mesenteric vein during surgery, which can be difficult if it passes behind the pancreas. By studying these anatomical features, the research aims to guide surgeons in performing safer and more effective surgeries for splenic flexure cancer.
In summary, the first part of the transcript introduces the speaker’s research on the complex vascular anatomy of the splenic flexure, emphasizing the need for detailed understanding of the blood vessels and lymphatic system to guide cancer surgeries. It discusses various challenges that surgeons face, including variations in vascular anatomy and the need for precise lymph node dissection. Through 3D imaging and modeling, the research provides valuable insights into these challenges to improve surgical outcomes for colon cancer patients.