Authors
Svyatnenko A.V.1, 2, Demko A.E.1, 2, Surov D.A.1, 2, Batig E.V.1, 2, Sizonenko N.A.2, Martynova G.V.1, Esayan I.L.2
1 Saint Petersburg I.I. Dzhanelidze research institute of emergency medicine, Saint Petersburg
2 S.M. Kirov Military Medical Academy, Saint Petersburg
Abstract
Justification. Augmented reality (AR) technology was introduced into surgery about 30 years ago, but has already become quite widespread in various fields of surgery. The article presents the first experience of using augmented reality technology in reconstructive surgery of the bile ducts.
The purpose of this publication is to highlight our own experience of using AR technology in reconstructive hepatobiliary surgery.
Methods. A clinical case of surgical treatment of patient P., 39 years old, with a history of surgery in October 2021 for Mirizzi syndrome type 4 is presented. A cholecystectomy was performed with an «end-to-end» anastomosis of the common bile duct on a T-shaped drainage. The postoperative period proceeded without early complications, however, the patient noted the preservation of jaundice of the skin, periodic darkening of urine. A month after the operation, according to magnetic resonance cholangiopancreatography data, an extended stricture from the upper third of the common hepatic duct was revealed. Upon admission to the Saint Petersburg I.I. Dzhanelidze research institute of emergency medicine in February 2022, the patient was fully examined, among the features — the level of total bilirubin was 206.2 mmol/l. The first stage was antegrade biliary decompression by percutaneous transhepatic external drainage of the biliary tract. Subsequently, taking into account the data of multispiral computed tomography-fistulography and multispiral computed tomography of the abdomen, a topographic and anatomical model was built in real time using augmented reality technology. Reconstructive surgery was planned and performed. Among the features, it should be noted a significant reduction in the time for determining and differentiating anatomical vascular and biliary structures in the liver gates against the background of a pronounced adhesive process when using AR. The reconstructive stage ended with the formation of a hepatic-eunoanastomosis on the loop of the small intestine in comparison with an inter-intestinal anastomosis.
Results. The postoperative period was uneventful. On day 17, magnetic resonance cholangiopancreatography was performed, where the complete consistency of the anastomosis and patency of the biliary tract were established. 3 months after the operation on the control magnetic resonance cholangiopancreatography, the biliodigestive anastomosis functions satisfactorily.
Conclusion. Our experience has shown that the use of AR in operations (especially repeated ones) on organs of the hepatopancreatoduodenal zone has good prospects and will reduce the time of intervention and the number of intraoperative complications.
Keywords: mechanical jaundice, augmented reality, percutaneous transhepatic drainage of the bile ducts, reconstructive surgery of the bile ducts, AR.
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