Three-Dimensional Imaging-Guided Safe Para-Aortic Lymph Node Dissection Using the Inferior Mesenteric Artery as an Intraoperative Landmark

Sep 30, 2026

Case Reports in Oncology documents a gynecologic oncology scenario where para-aortic lymph node dissection is planned with attention to unusual renal arterial anatomy. An endometrial cancer patient presented with three left renal arteries, including two located within the intended dissection area. Preoperative three-dimensional reconstruction with SYNAPSE VINCENT depicted vascular variation and enabled precise measurements from the inferior mesenteric artery to accessory arteries, guiding intraoperative identification and preservation, supporting surgical safety and improved anatomical understanding.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Case Presentation

Conclusion

Case Reports in Oncology | Case Rep Oncol 2026;19:46–51 | | | --- | --- | | DOI: 10. 1159/000549910
Received: October 27, 2025
Accepted: November 27, 2025
Published online: December 3, 2025 | © 2025 The Author(s) .
Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) | This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ([https://karger.com/Services/OpenAccessLicense](https://karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission. Case Report Three-Dimensional Imaging-Guided Safe Para-Aortic Lymph Node Dissection Using the Inferior Mesenteric Artery as an Intraoperative Landmark ina Patient with Renal Vascular Variation Daiki Idegami Yutaka Yoneoka Atsushi Murakami Hiroyuki Yamanaka Chiemi Ogawa Akimasa Takahashi Shunichiro Tsuji Tsukuru Amano Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan Keywords Renal artery variation · Endometrial cancer · Para-aortic lymph node dissection · SYNAPSE VINCENT · Three-dimensional imaging Abstract Introduction: In gynecologic oncology, para-aortic lymph node dissection is typically performed up to the level of the left renal vein. Although the renal arteries usually originate from the aorta, cranial to the renal veins, their anatomical course varies from person to person, and sometimes, the renal arteries are located within the para-aortic dissection area. Case Presentation: We present a case of endometrial cancer involving three left renal arteries, two of which were located caudal to the renal vein. Preoperative three-dimensional (3D) reconstruction accurately depicted the vascular variation and provided precise measurements from the origin of the inferior mesenteric artery (IMA) to the accessory arteries. During surgery, the IMA was used as a landmark to identify and preserve renal arteries during para-aortic lymph node dissection. Conclusion: This case demonstrates the practical advantages of preoperative 3D imaging in visualizing complex retroperitoneal vascular variation, ensuring surgical safety, and enhancing anatomical understanding in gynecologic oncology. © 2025 The Author(s) . Published by S. KargerAG, Basel Correspondence to: Tsukuru Amano, tsukuru [belle.shiga-med.ac.jp](belle.shiga-med.ac.jp) Case Reports in Oncology Case Rep Oncol 2026;19:46–51 47 | DOI: 10. 1159/000549910 | © 2025 The Author(s) . Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) | | --- | --- | Idegami et al.: 3D Imaging-Guided Para-Aortic Dissection Using IMA Landmark Introduction Three-dimensional (3D) imaging has become widespread in the medical field. In addition to conventional two-dimensional imaging using computed tomography (CT) and magnetic resonance imaging (MRI), 3D imaging makes it possible to grasp the course of blood vessels and tissues more accurately before and during surgery. The use of 3D imaging in preparation for surgery is common practice in many surgical fields. Using 3D imaging in cases, such as determining the extent of resection during lung or advanced colorectal cancer surgery, or the placement of implants during total hip arthroplasty, significantly reduced intraoperative blood loss and complications compared to cases in which 3D imaging was not used [1–4] . In gynecological surgery, the presence of significant individual variations in the renal vessels necessitates caution during para-aortic lymph node dissection. Moreover, the risk of vascular injury depends to some extent on the course of the vessels. The existence of aberrant renal arteries, particularly those located caudal to the renal vein, may lead to vascular injury, renal infarction, and impaired renal function [5–7] . However, the value of using 3D imaging for assessing such variations in gynecological surgery remains unknown. Herein, we present a case of en

FAQs

What role did the inferior mesenteric artery (IMA) play during the operation?

The surgical team used the IMA as an intraoperative landmark to identify and preserve renal arteries during para-aortic lymph node dissection, aiming for safe dissection within the planned area.

Sep 30, 2026

Uploaded by anakgang17