Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.
Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, 510280, China.
Surg Endosc. 2022 Aug;36(8):6326-6330. doi: 10.1007/s00464-022-09195-w. Epub 2022 May 19.
Foreign bodies that enter the pancreas and cause chronic complications cannot be removed by endoscopy. Surgical removal is necessary but also challenging. The development of augmented reality navigation has made it possible to accurate intraoperative navigation in laparoscopic surgery.
A 37-year-old female had epigastric pain for 3 months and her abdominal CT showed a linear high-density shadow in her pancreas along with chronic pancreatitis. Three-dimensional models of the liver, pancreas, stomach, blood vessels, and foreign body were created based on CT images. Gastroptosis was found in the three-dimensional models, so surgical approach was adapted to open the hepatogastric ligament to reach the pancreas. After 2-3 s of video images were captured by 3D laparoscopy, a three-dimensional dense stereo-reconstruction method was used to obtain the surface model of pancreas, stomach, and blood vessels. The Globally Optimal Iterative Closest Point method was used to obtain a spatial transformation matrix between the preoperative CT image space and the intraoperative laparoscopic space. Under augmented reality navigation guidance, the position and location of the foreign body were displayed on the surface of the pancreas. Then intraoperative ultrasound was used for further verification and to quickly and easily confirm the surgical entrance. After minimal dissection and removal of the pancreatic parenchyma, the foreign body was removed completely.
The operation time was 60 min, the estimated blood loss was 10 ml. The foreign body was identified as a 3-cm-long fishbone. The patient recovered without complications and was discharged on the third postoperative day.
Because it enables direct visual navigation via simple operation, ARN facilitates the laparoscopic removal of foreign bodies in the pancreas with accurate and rapid positioning and minimal damage.
进入胰腺并导致慢性并发症的异物不能通过内镜取出。需要手术切除，但也具有挑战性。增强现实导航的发展使得腹腔镜手术中实现精确的术中导航成为可能。
一名 37 岁女性因上腹痛 3 个月就诊，腹部 CT 显示胰腺内有一条线性高密度影，伴有慢性胰腺炎。根据 CT 图像创建了肝、胰腺、胃、血管和异物的三维模型。在三维模型中发现胃下垂，因此适应手术入路打开肝胃韧带以到达胰腺。在 3D 腹腔镜下拍摄 2-3 秒的视频图像后，使用三维密集立体重建方法获得胰腺、胃和血管的表面模型。使用全局最优迭代最近点方法获得术前 CT 图像空间和术中腹腔镜空间之间的空间变换矩阵。在增强现实导航的指导下，异物的位置和位置显示在胰腺表面。然后使用术中超声进一步验证，并快速轻松地确认手术入口。在最小程度地解剖和切除胰腺实质后，完全取出异物。
手术时间 60 分钟，估计出血量 10ml。异物被确认为 3 厘米长的鱼骨。患者无并发症恢复，术后第 3 天出院。
由于它通过简单的操作实现了直接可视化导航，ARN 有助于胰腺内异物的腹腔镜取出，具有准确快速的定位和最小的损伤。
