Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Endoscopic Research Unit, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Sci Rep. 2024 May 2;14(1):10055. doi: 10.1038/s41598-024-60647-w.
Endoscopic transgastric necrosectomy is crucial in the management of complications resulting from necrotizing pancreatitis. However, both real-time and visual-spatial information is lacking during the procedure, thereby jeopardizing a precise positioning of the endoscope. We conducted a proof-of-concept study with the aim of overcoming these technical difficulties. For this purpose, a three-dimensional (3D) phantom of a stomach and pancreatic necroses was 3D-printed based on spatial information from individual patient CT scans and subsequently integrated into a silicone torso. An electromagnetic (EM) sensor was adjusted inside the endoscope´s working channel. A software interface enabled real time visualization. The accuracy of this novel assistant system was tested ex vivo by four experienced interventional endoscopists who were supposed to reach seven targets inside the phantom in six different experimental runs of simulated endoscopic transgastric necrosectomy. Supported by endoscopic camera view combined with real-time 3D visualization, all endoscopists reached the targets with a targeting error ranging between 2.6 and 6.5 mm in a maximum of eight minutes. In summary, the EM tracking system might increase efficacy and safety of endoscopic transgastric necrosectomy at the experimental level by enhancing visualization. Yet, a broader feasibility study and further technical improvements are mandatory before aiming at implementation into clinical setting.
经内镜经胃坏死组织清除术对于治疗坏死性胰腺炎引起的并发症至关重要。然而，在该手术过程中缺乏实时和视觉空间信息，从而危及内镜的精确定位。我们进行了一项概念验证研究，旨在克服这些技术难题。为此，根据个体患者 CT 扫描的空间信息，对胃和胰腺坏死物的三维（3D）模型进行了 3D 打印，并将其整合到硅胶体中。在内镜工作通道内调整了电磁（EM）传感器。一个软件界面实现了实时可视化。该新型辅助系统的准确性通过四名经验丰富的介入内镜医生在六个不同的模拟经内镜经胃坏死组织清除术的实验中进行了体外测试，这四名医生被要求在模拟胃和胰腺坏死物的模型中到达七个目标。在结合内镜摄像头视图和实时 3D 可视化的情况下，所有内镜医生在最多 8 分钟内以 2.6 至 6.5 毫米的目标误差到达了目标。总之，EM 跟踪系统通过增强可视化，可能会在实验水平上提高经内镜经胃坏死组织清除术的疗效和安全性。然而，在将其应用于临床环境之前，还需要进行更广泛的可行性研究和进一步的技术改进。
