Skip to main content

Advertisement

SpringerLink
Log in

Augmented Reality-Guided Artery-First Pancreatico-Duodenectomy

  • Multimedia Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Augmented Reality (AR) in surgery consists in the fusion of synthetic computer-generated images (3D virtual model) obtained from medical imaging preoperative work-up and real-time patient images with the aim to visualize unapparent anatomical details. The potential of AR navigation as a tool to improve safety of the surgical dissection is presented in a case of pancreatico-duodenectomy (PD).

Methods

A 77-year-old male patient underwent an AR-assisted PD. The 3D virtual anatomical model was obtained from thoraco-abdominal CT scan using customary software (VR-RENDER®, IRCAD). The virtual model was superimposed to the operative field using an Exoscope (VITOM®, Karl Storz, Tüttlingen, Germany) as well as different visible landmarks (inferior vena cava, left renal vein, aorta, superior mesenteric vein, inferior margin of the pancreas). A computer scientist manually registered virtual and real images using a video mixer (MX 70; Panasonic, Secaucus, NJ) in real time. Dissection of the superior mesenteric artery and the hanging maneuver were performed under AR guidance along the hanging plane.

Results

AR allowed for precise and safe recognition of all the important vascular structures. Operative time was 360 min. AR display and fine registration was performed within 6 min. The postoperative course was uneventful. The pathology was positive for ampullary adenocarcinoma; the final stage was pT1N0 (0/43 retrieved lymph nodes) with clear surgical margins.

Conclusions

AR is a valuable navigation tool that can enhance the ability to achieve a safe surgical resection during PD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Neoptolemos JP, Stocken DD, Dunn JA, Almond J, Beger HG, Pederzoli P, Bassi C, et al. Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg 2001;234:758–768

    Article  PubMed  CAS  Google Scholar 

  2. Brennan MF, Kattan MW, Klimstra D, Conlon K. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg 2004; 240:293–8.

    Article  PubMed  Google Scholar 

  3. Estrella JS, Rashid A, Fleming JB, Katz MH, Lee JE, Wolf RA, et al. Post-therapy pathologic stage and survival in patients with pancreatic ductal adenocarcinoma treated with neoadjuvant chemoradiation. Cancer 2012; 118:268–77.

    Article  PubMed  Google Scholar 

  4. Verbeke CS, Gladhaug IP Resection margin involvement and tumour origin in pancreatic head cancer. Br J Surg 2012;99:1036–1049

    Article  PubMed  CAS  Google Scholar 

  5. Pessaux P, Regenet N, Arnaud JP Resection of the retroportal pancreatic lamina during a cephalic pancreaticoduodenectomy: first dissection of the superior mesenteric artery. Ann Chir 2003;128:633–636

    Article  PubMed  CAS  Google Scholar 

  6. Pessaux P, Varma D, Arnaud JP Pancreaticoduodenectomy: superior mesenteric artery first approach. J Gastrointest Surg 2006;10:607–611

    Article  PubMed  Google Scholar 

  7. Pessaux P, Rosso E, Panaro F, Marzano E, Oussoultzoglou E, Bachellier P, Jaeck D Preliminary experience with the hanging maneuver for pancreaticoduodenectomy. Eur J Surg Oncol 2009;35:1006–1010

    Article  PubMed  CAS  Google Scholar 

  8. Nicolau S, Soler L, Mutter D, Marescaux J Augmented reality in laparoscopic surgical oncology. Surg Oncol 2011;20:189–201

    Article  PubMed  Google Scholar 

  9. D'Agostino J, Diana M, Soler L, Vix M, Marescaux J 3D virtual neck exploration prior to parathyroidectomy. New Engl J Med 2012;367(11):1072–73

    Article  PubMed  Google Scholar 

  10. Marescaux J, Rubino F, Arenas M, Mutter D, Soler L Augmented-reality-assisted laparoscopic adrenalectomy. JAMA 2004;292:2214–2215

    PubMed  CAS  Google Scholar 

  11. Riall TS, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lym- phadenectomy for periampullary adenocarcinoma-part3: update on 5-year survival. J Gastrointest Surg 2005;9:1191–206

    Article  PubMed  Google Scholar 

  12. Sanjay P, Takaori K, Govil S, Shrikhande SV, Windsor JA 'Artery-first' approaches to pancreatoduodenectomy. Br J Surg 2012;99:1027–1035

    Article  PubMed  CAS  Google Scholar 

  13. Wong JC, Raman S. Surgical resectability of pancreatic adenocarcinoma:CTA. Abdom Imaging 2010;35:471–80.

    Article  PubMed  Google Scholar 

  14. Nam WH, Kang DG, Lee D, Lee JY, Ra JB Automatic registration between 3D intra-operative ultrasound and pre-operative CT images of the liver based on robust edge matching. Phys Med Biol 2012;57:69–91

    Article  PubMed  Google Scholar 

  15. Shekhar R, Dandekar O, Bhat V, Philip M, Lei P, Godinez C, Sutton E, et al. Live augmented reality: a new visualization method for laparoscopic surgery using continuous volumetric computed tomography. Surg Endosc 2010;24:1976–1985

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Anne-Blandine Mackowski and Mourad Bouhadjar for the 3D reconstruction and the audiovisual team at the IRCAD for their technical support. In addition, they would like to thank Guy Temporal and Christopher Burel for their valuable help in proofreading the manuscript.

Conflicts of Interest

The authors have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. IRCAD-IHU University Hospital of Strasbourg, 1 place de l’Hôpital, 67091, Strasbourg, France

    Ettore Marzano, Tullio Piardi, Luc Soler, Michele Diana, Didier Mutter, Jacques Marescaux & Patrick Pessaux

Authors
  1. Ettore Marzano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tullio Piardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luc Soler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michele Diana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Didier Mutter
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jacques Marescaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Patrick Pessaux
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patrick Pessaux.

Additional information

This work is part of the eHealth project PASSPORT funded by the ICT program of the European Community within the 7th Framework Program

Electronic supplementary material

Below is the link to the electronic supplementary material.

(MPG 10670 kb)

(MPG 13252 kb)

(MPG 14936 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marzano, E., Piardi, T., Soler, L. et al. Augmented Reality-Guided Artery-First Pancreatico-Duodenectomy. J Gastrointest Surg 17, 1980–1983 (2013). https://doi.org/10.1007/s11605-013-2307-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2307-1

Keywords

Search

Navigation