Tang Rui, Yang Wei, Hou Yucheng, Yu Lihan, Wu Guangdong, Tong Xuan, Yan Jun, Lu Qian
Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Institute for Precision Medicine, Tsinghua University, Beijing 102218, China.
Gastroenterol Res Pract. 2021 Mar 17;2021:9621323. doi: 10.1155/2021/9621323. eCollection 2021.
Pancreaticoduodenectomy (PD) with superior mesenteric vein (SMV) reconstruction are often required to achieve complete (R0) resection for pancreatic head cancer (PHC) with tumor invasion of the SMV. Augmented reality (AR) technology can be used to assist in determining the extent of SMV involvement by superimposing virtual 3-dimensional (3D) images of the pancreas and regional vasculature on the surgical field.
Three patients with PHC and tumor invasion of the SMV underwent AR-assisted PD with SMV resection and reconstruction following preoperative computed tomography scanning. Preoperative imaging data were used to reconstruct 3D images of anatomical structures, including the tumor, portal vein (PV), SMV, and splenic vein (SV). Using AR software installed on a smart phone, the reconstructed 3D images were superimposed on the surgical field as viewed in a smart phone display to provide intermittent navigational assistance to the surgeon in identifying the boundaries of PHC tumor invasion for resection of the vessels involved.
All patients successfully completed the operation. Intraoperative AR applications displayed virtual images of the pancreas, SMV, bile duct, common hepatic artery (CHA), and superior mesenteric artery (SMA). Two patients required end-to-end anastomosis for reconstruction of the SMV. One patient required allogenic vascular bypass to reconstruct the SMV-PV juncture with concomitant reconstruction of the SV-SMV confluence by end-to-side anastomosis of the SV and bypass vessel. Postoperative pathology confirmed R0 resections for all patients.
AR navigation technology based on preoperative CT image data can assist surgeons performing PD with SMV resection and reconstruction.
对于肿瘤侵犯肠系膜上静脉（SMV）的胰头癌（PHC），常需行胰十二指肠切除术（PD）并重建SMV以实现完整（R0）切除。增强现实（AR）技术可通过将胰腺及区域血管的虚拟三维（3D）图像叠加在手术视野上，辅助确定SMV受累范围。
3例PHC且肿瘤侵犯SMV的患者在术前行计算机断层扫描后，接受了AR辅助的PD并进行SMV切除与重建。术前影像数据用于重建包括肿瘤、门静脉（PV）、SMV和脾静脉（SV）在内的解剖结构的3D图像。利用安装在智能手机上的AR软件，将重建的3D图像叠加在智能手机显示屏上所看到的手术视野上，为外科医生在识别PHC肿瘤侵犯边界以切除受累血管时提供间歇性导航辅助。
所有患者均成功完成手术。术中AR应用展示了胰腺、SMV、胆管、肝总动脉（CHA）和肠系膜上动脉（SMA）的虚拟图像。2例患者需要行SMV端端吻合重建。1例患者需要进行同种异体血管搭桥以重建SMV-PV汇合处，并通过SV与搭桥血管的端侧吻合同时重建SV-SMV汇合处。术后病理证实所有患者均为R0切除。
基于术前CT图像数据的AR导航技术可辅助外科医生进行伴有SMV切除与重建的PD手术。
