Naito Shigetoshi, Kajiwara Masatoshi, Nakashima Ryo, Sasaki Takahide, Hasegawa Suguru
Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, JPN.
Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, JPN.
Cureus. 2023 Sep 1;15(9):e44520. doi: 10.7759/cureus.44520. eCollection 2023 Sep.
Background and purpose Laparoscopic liver resection (LLR) has recently gained popularity owing to advances in surgical techniques. Difficulties in LLR may be influenced by anatomical factors. This study presents a comprehensive overview of LLR performed using extended reality (XR) technology. Methods Six patients underwent LLR performed wearing HoloLens2® XR (Microsoft Corporation, Redmond, Washington, United States) technology. We performed dynamic contrast-enhanced CT scans before surgery and used the data to construct three-dimensional images. Results Of the six patients, two were diagnosed with colorectal liver metastases, two with hepatocellular carcinoma, and one with intrahepatic cholangiocarcinoma. The median maximum tumor diameter was 31 mm (range, 23-80 mm). One patient had liver cirrhosis, with Child-Pugh classification grade B. Anatomical resection was performed in three patients (60%), with a median difficulty score of 7 (intermediate). No conversions to open surgery were necessary. The median operative time and estimated blood loss were 444 minutes (range, 337-597 minutes) and 200 mL (range, 100-1000 mL), respectively. Postoperative complications (Clavien-Dindo classification grade II) were observed in one patient. All six cases achieved negative surgical margins. Conclusions LLR using XR technology enhances surgical visualization and anatomical recognition. The incorporation of XR technology into LLR offers advantages over traditional two-dimensional imaging.
背景与目的 由于手术技术的进步，腹腔镜肝切除术（LLR）近来颇受关注。LLR中的困难可能受解剖因素影响。本研究全面概述了使用扩展现实（XR）技术进行的LLR。方法 6例患者接受了佩戴HoloLens2® XR（美国华盛顿州雷德蒙德微软公司）技术进行的LLR。我们在手术前进行了动态对比增强CT扫描，并利用这些数据构建三维图像。结果 6例患者中，2例诊断为结直肠癌肝转移，2例为肝细胞癌，1例为肝内胆管癌。最大肿瘤直径中位数为31 mm（范围23 - 80 mm）。1例患者有肝硬化，Child-Pugh分级为B级。3例患者（60%）进行了解剖性切除，困难评分中位数为7（中等）。无需转为开放手术。手术时间中位数和估计失血量分别为444分钟（范围337 - 597分钟）和200 mL（范围100 - 1000 mL）。1例患者出现术后并发症（Clavien-Dindo分级II级）。所有6例均实现手术切缘阴性。结论 使用XR技术的LLR可增强手术可视化和解剖识别。将XR技术应用于LLR比传统二维成像具有优势。
