| BackgroundHepatolithiasis is prevalent in Southeast Asia,but rare in developed countries such as Europe and the United States.It is a complex disease with high recurrence rate,and has complications such as liver abscess and biliary cirrhosis,which seriously affects the patient’s physical and mental health and quality of life.Laparoscopic hepatectomy is the best method for management of hepatolithiasis.However,laparoscopic hepatectomy remains limited by inadequate tactile feedback,narrow surgical space,and limited endoscopic visual field and angle.In addition,the lesions of hepatolithiasis are often complicated with variation of pulse canal structure and atrophy of liver parenchyma.Surgeons can only make a rough judgment of the location and anatomical structure of stones based on their own experience,which is difficult to ensure surgical safety and accuracy.To address these issues,our team developed the 3D laparoscopic hepatectomy navigation system,which can integrates preoperative individualized threedimensional model,laparoscopic surgery scene and indocyanine green fluorescence images in real-time to achieve enhanced reality effects.It can realize visualization of key anatomical structure in the surgical field,accurately locate lesions and identify intrahepatic vasculature,so as to avoid inadvertent damage to important pipeline structure,and guide liver resection.The application of this system improves the safety and accuracy of surgery,and realizes the intraoperative transformation of preoperative planning,which has important clinical significance for the curative treatment of hepatolithiasis.Objective1.To study the application method of augmented reality navigation technology to realize real-time fusion of multi-mode images.2.To compare the clinical effects of augmented reality guided laparoscopic hepatectomy and conventional laparoscopic hepatectomy in the treatment of hepatolithiasis.3.To explore the clinical application value and significance of augmented reality guided laparoscopic segmental hepatectomy in the treatment of hepatolithiasis.Method1.We recollected clinical data of a total of 89 patients who diagnosed with intrahepatic cholangiolithiasis and treated with minimally invasive hepatectomy between January 2018 and December 2021,among of which,12 patients were excluded from the study for their diagnosis of cholangiocarcinoma confirmed by postoperative pathology.Patients in Group A(n=31)underwent augmented realityguided laparoscopic hepatectomy,while patients in Group B(n=46)received conventional laparoscopic hepatectomy.The preoperative data,preoperative and postoperative test indicators,surgical indicators,immediate stone residue rate,stone recurrence rate,postoperative hospital stays and postoperative complication between the two groups were compared and analyzed.All statistical analyses were performed using SPSS 25.0,significance p<0.05 was considered as a statistical difference.2.Clinical data of a total of 16 patients diagnosed with intrahepatic bile duct stones and undergoing laparoscopic anatomic segmental hepatectomy were collected from January 2018 to December 2022.Among them,1 patient was excluded due to postoperative pathologic evidence of intrahepatic papillary tumor,and 15 patients were finally included.Three-dimensional models were constructed for preoperative assessment of all patients,and ICG was injected 24-72h before surgery.The observation was based on(1)the effect of augmented reality technology for focal location;(2)the recognition of intrahepatic vessels guided by augmented reality technology;(3)the situation of segmental liver imaging;(4)the evaluation indexes related to perioperative efficacy.Results1.There was no significance difference in preoperative data between the two groups(p>0.05).The Group A had a longer surgical time than the Group B(367.35±99.66 VS 271.46±123.36,p<0.001).The intraoperative blood loss in the Group A was lower than that in the Group B(112.90±67.98 VS 206.74± 129.17,P<0.001).Alanine transaminase,aminotransferase in the Group A were prominently lower than in the Group B(46.37±24.81 VS 79.38±51.33,P=0.001;25.13±12.28 VS 45.52±32.64,P=0.002).No severe complications and death occurred after operation in either group.The immediate postoperative stone residual rate(19.4%vs 41.3%,p=0.044),the stone recurrence rate(12.5%vs 30.4%,p=0.046),and the stone extraction rate of T tube sinus tract(15%vs 34.8%,p=0.036)in the Group A were substantially less than those in the Group B.2.Augmented reality navigated laparoscopic segmental hepatectomy of 15 patients were successfully completed.Augmented reality technology can be used to accurately locate lesions,define the plane of broken liver,identify intrahepatic vessels,and detect biliary leakage.Among,13 patients underwent laparoscopic left external lobe resection,1 patient underwent laparoscopic right anterior lobe resection,and 1 patient underwent laparoscopic S4+S8 resection.The operation time was 364.2±43.67min,the intraoperative blood loss was 96.67±26.38ml,only 1 patient received intraoperative blood transfusion.The postoperative hospitalization time was 7.87±10.77 days,and the T-tube indentation time was 79.28±0.47 days.The stone residual rate was 13.3%,and the stone recurrence rate was 6.7%.Conclusions1.The application of the augmented reality-assisted navigation system in hepatectomy for hepatolithiasis has shown significant advantages in reducing intraoperative blood loss,immediate stone residual rate,and stone recurrence rate.2.Augmented reality navigation technology can help surgeons accurately locate the lesions,define the resection plane of the liver,identify intrahepatic vasculature,and detect biliary leakage,thus greatly improving the accuracy of laparoscopic segmentectomy.3.Augmented reality-guided hepatectomy is a feasible and safe method for the treatment of hepatolithiasis,which has the value of clinical promotion. |
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