混合现实技术在精准肝胆外科手术中应用研究

目的 探讨混合现实技术在肝胆外科手术中的应用.方法 回顾性分析2019年1月至12月清华大学附属北京清华长庚医院收治的7例接受混合现实技术辅助肝胆手术病人临床资料,包括泡型肝棘球蚴病3例、肝内胆管结石1例、胆管囊状扩张症1例、肝胚胎性肉瘤1例及亲体肝移植供者1例.病人均行腹部增强CT检查,将数据运用结合人工智能全定量混...

Application of mixed reality in precise hepatobiliary surgery

ObjectiveTo investigate the application of mixed reality technology in hepatobiliary surgery.MethodsA retrospective research was conducted to analyze the clinicopathological data of 7 patients who underwent mixed reality technology-assisted hepatobiliary surgery from January to December 2019 in Beijing Tsinghua Changgung Hospital of Tsinghua University.Seven patients included 3 cases of alveolar hepatic hydatid disease,1 case of intrahepatic bile duct stones,1 case of cystic dilatation of the bile duct,1 case of hepatic embryonic sarcoma and 1 case of a parent liver transplant donor.The patients underwent enhanced abdominal computed tomography(CT).The data of enhanced CT scan was combined with artificial intelligence QMR(Quantitative Mixed Reality)technology for preoperative evaluation and planning of the surgery.Reconstructed the three-dimensional(3 D)holographic organ which displayed in real-time fusion and matching with the anatomical structures of the recipient’s organs,vessels,tumors and so on in the real surgical environment,aiming to obtain the"perspective"quantitative three-dimensional information of the surgical site,perform intraoperative navigation and collect data such as liver volume.The endpoint of follow-up was 6 months later after surgery.Results operation of 7 patients was performed synchronouslywith the operation process by surgeon.The medianoperation time was 12.12(6.17—14.25)h,and themedian blood loss was 800(100—1500)m L,themedian postoperative hospitalization was 14(7—23)d.After the operation,one patient had complications of intestinal anastomosis bleeding,and the second operation wasperformed to stop the bleeding.The rest recovered without postoperative complications nor perioperative death.Intraoperative navigation matching situation,intraoperative mixed reality navigation were matched with actual anatomicalstructure registration.The median QMR registration duration of 7 patients was 7(5—10)min,which accounted for 1.19%(0.80%—1.41%)of the whole operation time.After registration,intraoperative navigation was utilized intermittently todistinguish important anatomical structures,including 3 cases of common hepatic artery,6 cases of proper hepatic artery,3 cases of left hepatic vein,2 cases of middle hepatic vein,3 cases of right hepatic vein,and 5 cases of portal vein.At thesame time,navigation was used for bile duct anatomy protection,and 5 cases of common bile duct,3 cases of left hepaticduct and 2 cases of right hepatic duct were processed.The QMR system accurately displayed 7 cases of sectionnavigation,with a registration error of 7(2—17)mm.Follow-up status:7 patients received regular follow-up visits to 6 months later after surgery,and recovered well until the end of follow-up.There was no recurrence in tumor patients.ConclusionFull quantitative mixed reality technology can quantitatively extract,construct,navigate,restore,andregister key information of the 3 D structure during the operation.The surgeon can interact with it in real time to evaluateand guide the implementation of the resection plan,thereby assisting hepatobiliary surgery to achieve visualization,quantification,and controllable precise resection targets.