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Background The impact of the position of the middle colic artery (MCA) bifurcationand the trajectory of the accessory MCA (aMCA) on adequate lymphadenectomy whenoperating colon cancer have as of yet not been described and/or analysed in theliterature. The aim of this study was to determine the MCA bifurcation position toanatomical landmarks and to assess the trajectory of aMCA. Methods The colonic vascular anatomy was manually reconstructed in 3D fromhigh-resolution CT datasets using Osirix MD and 3-matic Medical and analysed. CTdatasets were exported as STL files and supplemented with 3D printed models whenrequired. Results Thirty-two datasets were analysed. The MCA bifurcation was left to thesuperior mesenteric vein (SMV) in 4 (12.1%), in front of SMV in 17 (53.1%) and rightto SMV in 11 (34.4%) models. Median distances from the MCA origin to bifurcation were3.21 (1.18–15.60) cm. A longer MCA bifurcated over or right to SMV, while a shorterbifurcated left to SMV ( r  = 0.457,  p  = 0.009). The main MCA direction was towards right in19 (59.4%) models. When initial directions included left, the bifurcation occurredleft to or anterior to SMV in all models. When the initial directions included right,the bifurcation occurred anterior or right to SMV in all models. The aMCA was foundin 10 (31.3%) models, following the inferior mesenteric vein (IMV) in 5 near thelower pancreatic border. The IMV confluence was into SMV in 18 (56.3%), splenic veinin 11 (34.4%) and jejunal vein in 3 (9.4%) models. Conclusion Awareness of the wide range of MCA bifurcation positions reported iscrucial for the quality of lymphadenectomy performed. The aMCA occurs in 31.3% modelsand its trajectory is in proximity to the lower pancreatic border in one half ofmodels, indicating that it needs to be considered when operating splenic flexurecancer.

surgical endoscopy/surgical endoscopy and other interventional techniques

Re-interpreting mesenteric vascular anatomy on 3D virtual and/or physical models: positioning the middle colic artery bifurcation and its relevance to surgeons operating colon cancer