增强现实技术联合ICG分子荧光影像导航3D腹腔镜右半肝切除术(附视频)

Augmented reality combined with ICG molecular fluorescence imaging-navigated 3D laparoscopic right hepatectomy(video attached)

目的探讨增强现实(AR)联合吲哚氰绿(ICG)分子荧光影像技术导航3D腹腔镜右半肝切除术的可行性与安全性。方法本研究对象为2019年4月在南方医科大学珠江医院行AR联合ICG分子荧光影像导航3D腹腔镜右半肝切除术的1例肝癌患者。患者男,56岁,诊断原发性肝癌,中国原发性肝癌诊疗规范(2017年版)分期为Ⅰb期。患者签署知情同意书,符合医学伦理规定。采用三维可视化技术进行术前评估和虚拟肝切除,“五孔法”行3D腹腔镜右半肝切除术,采用AR技术将三维模型与3D腹腔镜手术图像进行实时融合,联合ICG分子荧光影像技术进行手术实时导航肝切除。观察患者术中及术后情况。结果术前三维可视化评估示肿瘤主要位于Ⅶ、Ⅷ段,压迫肝右静脉,且肝动脉存在变异,肝右动脉起源自肠系膜上动脉。虚拟仿真右半肝切除示切除肝体积796.6 ml,剩余肝体积529.0 ml,剩余肝体积占全肝体积40%。术中采用AR技术和ICG分子荧光影像技术,观察肝脏表面未发现转移病灶,沿荧光分界线标记出肝切除平面,与缺血线相一致。患者顺利完成手术。手术时间360 min,术中出血量250 ml。术后病理学检查示肝细胞癌。术后未发生出血、胆漏、肝衰竭等严重并发症。术后住院时间7 d。结论AR联合ICG分子荧光影像技术实时导航3D腹腔镜右半肝切除安全、可行,具有较高的临床应用价值。

Objective To explore the feasibility and safety of 3D laparoscopic right hepatectomy guided by augmented reality(AR)combined with indocyanine green(ICG)molecular fluorescence imaging technology.Methods One patient with liver cancer who underwent 3D laparoscopic right hepatectomy navigated by AR combined with ICG molecular fluorescence imaging in Zhujiang Hospital of Southern Medical University in April 2019 was enrolled in this study.The male patient,aged 56 years,was diagnosed with stageⅠb primary liver cancer according to Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China(2017 Edition).The informed consent of the patient was obtained and the local ethical committee approval was received.Preoperative evaluation and virtual hepatectomy were performed by 3D visualization technology.The 3D laparoscopic right hepatectomy was performed through 5-port approach.The images of 3D models and 3D laparoscopic right hepatectomy were fused in a real-time manner by AR technology.Hepatectomy was conducted with real-time navigation,combining with ICG molecular fluorescence imaging technology.Intraoperative and postoperative conditions of the patient were observed.Results Preoperative 3D visual evaluation demonstrated that the tumor was mainly located in the segmentsⅦandⅧ,compressing the right hepatic vein.In addition,variations were observed in the hepatic artery.The right hepatic artery originated from the superior mesenteric artery.Virtual right hepatectomy simulation showed that the resected liver volume was 796.6 ml,and the remaining liver volume was 529.0 ml,accounting for 40%of the total liver volume.Intraoperatively,AR and ICG molecular fluorescence imaging technologies were employed to identify no metastatic lesions on the liver surface.The liver resection surface was marked along the fluorescence demarcation line,which was consistent with the ischemia line.The operation was completed successfully.The operation time was 360 min and intraoperative blood loss was 250 ml.Postoperative pathological examination confirmed the diagnosis of hepatocellular carcinoma.No severe complications,such as hemorrhage,bile leakage and liver failure,occurred after the operation.The length of postoperative hospital stay was 7 d.Conclusions AR combined with ICG molecular fluorescence imaging technologynavigated 3D laparoscopic right hepatectomy is safe and feasible,which has high clinical application value.