Augmented reality navigation system makes laparoscopic radical resection of hilar cholangiocarcinoma type Ⅲb more precise and safe.

Abstract

BackgroundLaparoscopic radical resection of hilar cholangiocarcinoma is highly demanding and challenging, especially the anatomical dissection of hilar and total caudate lobe vessels1. During abdominal surgery, Augmented Reality Navigation (ARN) can provide real-time intraoperative navigation to enhance the visualization of invisible anatomical structures2,3. During the procedure of hepatectomy, the Augmented Reality Navigation (ARN) system independently developed by our team can project the preoperative individualized three-dimensional model into the visual field of laparoscopic surgery, and accurately locate and identify the tumor and intrahepatic vascular system during the operation, so as to avoid the collateral damage of important pipeline structures. improve the safety of the operation. We recently had a patient who underwent pure laparoscopic left hepatectomy and lymph node dissection and hepaticojejunostomy under ARN for treating hilar cholangiocarcinoma type Ⅲb safely and accurately. MethodsA 59-year-old man was admitted to hospital with painless obstructive jaundice. The tumor was 17 × 10 × 8mm in diameter and located in the right bile duct and common hepatic duct. Radiological examination showed that the tumor was so close to the right hepatic artery that it could hardly be completely dissected. First, the 3D visualization software was used to reconstruct preoperative 3D models and develop a virtual hepatectomy plan. Then, during the operation, the ARN system was used to "skeletonize" the first hepatic hilum, and the right hepatic artery and tumor were separated under real-time navigating. After the left hepatic artery, middle hepatic artery and left portal vein were ligated and severed respectively, the parenchymal transection was accurately identified by virtual liver segment projection in ARN system and ICG negative staining combined with intraoperative ultrasound. Next, after the complete hepatic parenchyma is transected along the middle hepatic vein, the caudate is completely dissected and all the short hepatic veins are fully dissected and transected. Finally, right hepatic bile duct jejunum Roux-en-Y reconstruction was performed. ResultsThis patient underwent successfully with a laparoscopic surgery under the guidance of augmented reality navigation. The operation time was nearly 620min, and the intraoperative blood loss was about 350ml. No complication was observed and the postoperative hospital stay was 9 days. The final diagnosis of the hilar cholangiocarcinoma with no lymph node metastasis was pT2bNxMx stage II (American Joint Committee on Cancer, AJCC). No tumor recurrence was found by CT/MRI at 17 months postoperative period. ConclusionsThe Augmented Reality Navigation system makes laparoscopic radical resection of hilar cholangiocarcinoma type Ⅲb more precise and safe.