Onda Shinji, Okamoto Tomoyoshi, Kanehira Masaru, Suzuki Fumitake, Ito Ryusuke, Fujioka Shuichi, Suzuki Naoki, Hattori Asaki, Yanaga Katsuhiko
Division of Digestive Surgery, The Jikei University Graduate School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.
J Hepatobiliary Pancreat Sci. 2014 Apr;21(4):281-7. doi: 10.1002/jhbp.25. Epub 2013 Aug 22.
In pancreaticoduodenectomy (PD), early ligation of the inferior pancreaticoduodenal artery (IPDA) before efferent veins has been advocated to decrease blood loss by congestion of the pancreatic head to be resected. In this study, we herein report the utility of early identification of the IPDA using an augmented reality (AR)-based navigation system (NS).
Seven nonconsecutive patients underwent PD using AR-based NS. After paired-point matching registration, the reconstructed image obtained by preoperative computed tomography (CT) was fused with a real-time operative field image and displayed on 3D monitors. The vascular reconstructed images, including the superior mesenteric artery, jejunal artery, and IPDA were visualized to facilitate image-guided surgical procedures. We compared operating time and intraoperative blood loss of six patients who successfully underwent identification of IPDA using AR-based NS (group A) with nine patients who underwent early ligation of IPDA without using AR (group B) and 18 patients who underwent a conventional PD (group C).
The IPDA or the jejunal artery was rapidly identified and ligated in six patients. The mean operating time and intraoperative blood loss in group A was 415 min and 901 ml, respectively. There was no significant difference in operating time and intraoperative blood loss among the groups.
The AR-based NS provided precise anatomical information, which allowed the surgeons to rapidly identify and perform early ligation of IPDA in PD.
在胰十二指肠切除术（PD）中，有人主张在离断静脉之前早期结扎胰十二指肠下动脉（IPDA），以通过使待切除的胰头充血来减少失血。 在本研究中，我们在此报告使用基于增强现实（AR）的导航系统（NS）早期识别IPDA的效用。
7例非连续性患者接受了基于AR的NS的PD手术。 经过配对点匹配注册后，将术前计算机断层扫描（CT）获得的重建图像与实时手术视野图像融合，并显示在3D监视器上。 可视化包括肠系膜上动脉、空肠动脉和IPDA在内的血管重建图像，以促进图像引导的手术操作。 我们比较了6例使用基于AR的NS成功识别IPDA的患者（A组）、9例未使用AR进行IPDA早期结扎的患者（B组）和18例接受传统PD手术的患者（C组）的手术时间和术中失血量。
6例患者迅速识别并结扎了IPDA或空肠动脉。 A组的平均手术时间和术中失血量分别为415分钟和901毫升。 各组之间的手术时间和术中失血量没有显著差异。
基于AR的NS提供了精确的解剖信息，使外科医生能够在PD手术中快速识别并早期结扎IPDA。
