3D-assisted virtual cholangioscopy

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3D-assisted virtual cholangioscopy

Authors

M Simone, J Marescaux

Keywords

3D-assisted virtual cholangioscopy,cholangio

Media type

Surgical video

Duration

04'00''

Publication

2005-07

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E-publication

WeBSurg.com, Jul 2005;5(07).
URL: http://www.websurg.com/doi-vd01en1591e.htm

3D-assisted virtual cholangioscopy

1. Virtual cholangioscopy 00'08''

This video will demonstrate 3D-assisted cholangioscopy. We start with a complete digitized format of the MRI scan in order to create the virtual reality model of the biliary tree. The digitized images have a very wide range of grey scale, and therefore the reconstructions can be made with a resolution higher than what would be interpreted by the human eye. There are some gallstones in the gallbladder as shown.

2. Virtual navigation 00'39''

Now to the navigation. Through the virtual cholangioscope, the position of which is shown on the image on the right, it is possible to navigate through the biliary tree and visualize the intraluminal surface, which is shown on the left. Here we can see a gallstone at the bottom of the common bile duct, which is measured. These images can be displayed and manipulated on a standard laptop, which can be brought to the operating room, and therefore facilitate the surgical procedure. The navigation through the biliary tree is continued to complete the virtual examination.

3. Trocar placement and dissection of Calot\'s triangle 01'13''

Now to the operating room. The trocar positions which will be used for the cholecystectomy and biliary exploration are shown. First, the gallbladder is retracted upwards for exposure. The peritoneum is then opened over the area of Calot’s triangle in order to isolate the structures within. Here we see the cystic duct and artery demonstrated very clearly. Virtual reality can help the surgeon during the dissection, particularly if there is atypical anatomy and risk of damage to important structures. The artery is clipped as shown. The cystic duct is then ligated at the neck of the gallbladder. The artery is then cut. A swab is placed to protect the peritoneum from bile. The cystic duct is then also tied at the junction with the common bile duct. The dissection is now continued inferiorly in order to isolate the common bile duct.

4. Cholangioscopy 02'45''

Here we see the biliary anatomy demonstrated clearly. A small choledochotomy is made in the common bile duct, and we can see the bile appearing. The hole is extended to accommodate the cholangioscope. We can now compare the images from the cholangioscope to that of the virtual cholangioscopy. The gallstone at the bottom of the common bile duct is visualized. A basket is used to extract the stone as shown. An inspection is then performed of the rest of the biliary tree, which looks normal.

5. T-tube insertion 03'38''

A T-tube is inserted carefully and the choledochotomy is closed over this.

6. Cholecystectomy 03'54''

The operation is completed by performing the cholecystectomy using the conventional technique. The gallbladder is extracted within an Endobag. We can see the safe passage of contrast through the biliary tree into the duodenum on this postoperative contrast study.