Revista nº 814

Trebollé JF, et al. | 3D morphometric analysis of the cadaveric colon 261 Actual Med. 2021; 106(814): 260- 270 Colon morphology has been extensively described in classical treatises of human anatomy (1,2) and has been related to both visceral and bony neighboring structures. (3,4) There is considerable anatomical variability of the colon, which can mostly be explained by embryological development. The rotation of the intestinal loops influences the location of the different segments. (5) The fusion of the peritoneal layers that occurs during the formation of the mesos and coalescence fascia can influence the length of certain sections of the colon and the positioning of its angles. (6) The anatomical study of the colon has employed analytical methods based on radiological images and t he r e s u l t i ng t h r e e - d imens i ona l r e c ons t r u c t i ons , i nc l ud i ng c ompu t e r i z e d t omog r aphy (CT) , nu c l e a r ma gne t i c r e s onanc e (MRI ) or v i r t u a l c o l ono s c opy (CT- c o l onoscopy). (7-10) With these techniques, it is possible to analyze how age, sex, body mass index and pelvic diameter can inf luence the morphology, the disposition of f ixed points or the intraluminal volume of the colon, among other parameters, (11) and the anatomy of this organ can be studied by moving the patient f rom a supine decubitus position to a prone or lateral decubitus position, an adjustment that is highly applicable in clinical practice. (12-14) During laparoscopic surgery of the colon, different decubitus positions have been proposed to facilitate the correct mobilization of the intra-abdominal viscera and thus achieve good colon exposure. (15) For example, to expose the sigmoid colon, the surgical table is placed in the Trendelenburg position, and to examine the splenic flexure and the descending colon, a certain degree of right lateral decubitus positioning is used. (16-17) Therefore, for a successful surger y, it is considered necessar y to var y the position of the patient so that the disposition of the colon is also modified. No reference has been found in the literature that specifically describes the changes in colon placement that result from changes in posture. Advantages and limitations of the technique. The main advantage of this technique is that it is possible an evaluation of morphological changes that appear in an organ, in different pathological conditions, or as the effect of an intervention strategy. Also, this technique provides an important means of quantifying aspects of shape variation and enable visualization of these shape differences in a framework that is independent of differences in size between objects or specific regions. The main problem with small studies is interpretation of results, in particular confidence intervals and p-values. Another major limitation is that they can produce false-positive results, or they over-estimate the magnitude of an association. In this case, a larger confirmatory study is needed. In this study, we propose as a hypothesis that certain points of the colon change location depending on the decubitus position that is used and that these changes can be measured and analyzed using radiological methods with three-dimensional reconstruction. Cadavers. Placement and manipulation The study was performed at the Jesus Uson Minimally Invasive Surgery Centre with three cadavers, two females (cadavers 1 and 3) and one male (cadaver 2), embalmed using the Thiel technique. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/ or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The need for written and informed consent for use of the patients’ cadaver for research purposes was not required because of the retrospective study design and the requirement was waived by Clinical Research Ethics Committee of Aragón (CEICA). The use of the images and the retrospective collection of data were approved by the Clinical Research Ethics Committee of Aragón (CE PI17/O168); data confidentiality and permission of data review were provided in the hospital admission consent. A Brilliance CT multi-cutter scanner was used (Philips Medical Systems, Nederland B.V). The image processing and measurement software used were OsiriX, Adobe Photoshop Elements 11 Editor and ImageJ. A working protocol was established and repeated for the three cadavers. The cadavers were placed in the scanner on wooden wedges at a 15º angle to achieve the different postural changes. The pneumoperitoneum was created with a periumbilical Veress needle. Four 12-mm disposable trocars were placed in the epigastric periumbilical and both iliac fossa locations for the introduction of a 0° Storz scope and disposable forceps in the series required for the manipulation of the colon. The ten series of the study were modified with different degrees of pneumoperitoneum and postural decubitus. Series 01 (BASELINE) was a INTRODUCTION MATERIAL AND METHODS