Application Of Three-dimensional Visualization Technology In Laparoscopic Pancreatoduodenectomy

Background: Laparoscopic pancreaticoduodenectomy,the standard minimally invasive approach to treating tumours in the head of the pancreas and around the jugular,is recognised as one of the most complex and challenging procedures in the abdomen.The spatial location of the tumour in relation to its surrounding vessels,common bile duct,main pancreatic duct and other structures needs to be accurately identified preoperatively in order to assess whether the tumour is resectable.Currently,computed tomography and magnetic resonance imaging are the main preoperative imaging tests,but they have limitations in assisting the surgeon to determine the exact location and boundaries of the tumour.This creates a great deal of uncertainty in the preoperative assessment and greatly reduces the success rate of surgery.With the rapid development of digital medicine,the application of three-dimensional visualisation technology in the medical field has received more and more attention.This method is in the form of a three-dimensional three-dimensional model showing the anatomical structure between each organ and its characteristics in relation to the tumour space and morphology,guiding the selection of the best surgical plan.At this stage three-dimensional visualisation techniques have been widely used in orthopaedics,neurosurgery,urology,cardiothoracic surgery and other related medical fields.However,the application of three-dimensional visualisation technology in laparoscopic pancreaticoduodenectomy is still rare and there is a lack of more relevant clinical studies.Objective: The clinical usefulness of three-dimensional visualization technology in single-center laparoscopic pancreaticoduodenectomy was investigated by comparing the differences between three-dimensional visualization technology and conventional imaging in the treatment of patients undergoing laparoscopic pancreaticoduodenectomy.Method: Clinical data were collected from 66 patients who underwent laparoscopic pancreaticoduodenectomy in the Department of General Surgery,Jinpu Hospital,The First Affiliated Hospital of Dalian Medical University from January 2019 to September2022,of whom 36 patients underwent preoperative stereoscopic three-dimensional visualization model reconstruction(experimental group)and 30 patients underwent preoperative enhanced CT examination only(control group),and the postoperative pathological findings in both groups were pancreatic head or peri-potbelly malignant tumour.The relevant clinical data of the two groups were collected,and the differences between the two groups in terms of operative length,time to reconstruction of the digestive tract,number of lymph nodes dissected,intraoperative bleeding,perioperative complications,time of postoperative drainage tube removal and hospital stay were compared and retrospectively analyzed in a clinical case-control study to assess the value of the application of three-dimensional visualization technique in laparoscopic pancreaticoduodenectomy.Results: The general observations such as gender,age and preoperative combined underlying disease of the two groups in this study were not significantly different and were comparable(P > 0.05).The pancreatic-intestinal anastomosis time was significantly shorter in the experimental group(17.97±4.55)minutes compared with the control group(24.83±9.76)minutes,and the difference between the groups was statistically significant(t=-3.54,P=0.001).Intraoperative bleeding was significantly lower in the experimental group(61.94±81.42)millilitres compared to the control group(158.00±142.48)millilitres,with a statistically significant difference(t=-3.27,P=0.002).The number of lymph nodes cleared was significantly higher in the experimental group compared to the control group,with a statistically significant difference(Z=-4.05,P<0.001).The postoperative hospital stay was shorter in the experimental group(15.06±3.77)days compared to the control group(22.69±11.16)days,with a statistically significant difference between the groups(t=-3.54,P=0.001).The time to remove the abdominal drain was shorter in the experimental group(14.31±4.47)days compared to the control group(22.87±12.66)days,with a statistically significant difference(t=-3.53,P=0.001).The preoperative values of the diameter of the main pancreatic duct,the thickness of the pancreas at the neck of the pancreas and the distance between the main pancreatic duct at the neck of the pancreas and the peritoneum of the posterior wall of the pancreas were measured by threedimensional visualization technique and the results were found to be not significantly different from the intraoperative measurements(P > 0.05).In the experimental group,the duration of surgery was(3.55±0.71)hours,the duration of biliary-intestinal anastomosis was(12.03±2.64)minutes and the duration of gastrointestinal anastomosis was(10.55±3.00)minutes;in the control group,the duration of surgery was(3.83±0.64)hours,the duration of biliary-intestinal anastomosis was(13.17±2.67)minutes and the duration of gastrointestinal anastomosis was(11.67±2.81)minutes.The differences between the two groups in each of these indicators were not statistically significant(P > 0.05).There was no statistically significant difference between the two groups in the data related to perioperative complications(P>0.05).Conclusion: Three-dimensional visualisation is a technique that transforms traditional two-dimensional planar imaging images into personalised three-dimensional images.Through the preoperative use of three-dimensional visualisation,disease diagnosis and analysis,resectability assessment and identification of abnormal anatomical structures are accurately performed on malignant tumours in the head of the pancreas and around the jugular.It is clinically important for preoperative planning,selection of the best surgical pathway to perform laparoscopic pancreaticoduodenectomy,shortening the time to reconstruct the digestive tract and reducing intraoperative medically induced vascular injury.