Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Methods
2.2.1. Endoscopic Instrumentation
2.2.2. Three-Dimensional (3D) Models
2.2.3. Virtual Reality HMD Model
2.2.4. Preoperative Virtual Reality HMD Setup Evaluation
2.2.5. Surgical Approach
3. Results
3.1. Patients’ Data
3.2. Preoperative Planning and Operations
3.2.1. Congenital Malformations (Duplication Cysts)
3.2.2. Biliary Tree Abnormalities
3.2.3. Proliferative Disorders
3.3. Post-Operative Management
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Congenital Malformations (Duplication Cysts) | ||||
---|---|---|---|---|
1 | 2 | 3 | ||
Patients age, weight | Female 24 months 12 kg | Female 10 months 10 kg | Female 180 months 59 kg | |
Symptoms | No | No | No | |
Diagnosis (prenatal evaluation yes/no) | Multiple gastric duplication Cyst (yes) | Esophageal duplication cyst (yes) | Duodenal duplication cyst | |
Radiological investigations | MR, US, EUS, X-ray | US, MR, CT-scan, barium swallow | US, MRI | |
Endoscopic instrumentation | EBUS | EBUS | EG-3870UTK Linear-Array Ultrasound Gastroscope | |
Management | MIS (laparoscopic resection of gastric duplication cysts) | MIS (thoracoscopic resection of esophageal duplication cyst) | Planned endoscopic removal by unroofing and mucosectomy | |
Endoscopic Advantages/Limitations | Reduction in the diagnostic possibilities by identification of cysts surrounded by gastrointestinal wall layers | Definition of the relationships with surrounding tissues | Anatomical definition of surrounding structures (in particular, the biliary tree and pancreatic duct) | |
Biliary Tree Abnormalities Malformative/Congenital | ||||
4 | 5 | 6 | 7 | |
Patients age, weight | Female 192 months 60 kg | Male 55 months 14 kg | Male 120 months 27 kg | Male 8 months 9 kg |
Symptoms | Acute pancreatitis, pain in right hypochondrium | Icterus, pancreatitis | Chronic pancreatitis with choletithiasis, genetic-based | No |
Diagnosis (prenatal evaluation yes/no) | Cholelithiasis and choledocholithiasis in duodenal atresia (duodeno-jejuno anastomosis at birth) and pancreas divisum (yes) | Choledochal cyst (Todani I) and choledocholitiasis (no) | Mutation of the gene PRSS1, Cholelitiasis, pancreatic duct duplication (no) | Gallbladder duplication Annular pancreas Duodenal duplication (yes) |
Radiological investigations | US, MR, CT Scan, VR HMD | US, Cholangio MR | US, X-ray, Cholangio MR, CT, VR HMD | US, Cholangio MR, CT |
Endoscopic instrumentation | EG-3870UTK Linear-Array Ultrasound Gastroscope | EBUS + Duodenoscope | Duodenoscope, EG-3870UTK Linear-Array Ultrasound Gastroscope | EBUS |
Management | MIS (laparoscopic cholecisectomy) with LCBDE | 1. ERCP + sphincterotomy + stone removal 2. Open surgery: choledochal cyst removal and Roux-en-Y bilio-digestive anastomosis | 1. EUS + ERCP + stent placement + sphincterotomy + DASE; MIS (laparoscopic cholecystectomy) with LCBDE 2. ERCP and pancreatic stent replacement | MIS (laparoscopic cholecystectomies) with attempted LCBDE (failure for fibrosis) |
Endoscopic Advantages/Limitations | Anatomical definition ERCP technically impossible for difficulties in reaching the papilla | Diagnostic and therapeutic procedures | Effective biliopancreatic drainage permitted postponed cholecystectomy and pancreatic preservation | Anatomical definition |
Biliary Tree Abnormalities Idiophatic Lithiasis | ||||
8 | 9 | 10 | ||
Patients age, weight | Male 192 months 80 kg | Female 144 months 58 kg | Male 20 days 3.5 kg | |
Symptoms | Acute pancreatitis | Abdominal pain | Cholestatic icterus | |
Diagnosis (prenatal evaluation yes/no) | Cholelitiasis (no) | Cholelitiasis (no) | Non-syndromic paucity of interlobular bile ducts (no) | |
Radiological investigations | US, cholangio-MR, CT Scan | US, cholangio-MRI | US | |
Endoscopic instrumentation | EG-3870UTK Linear-Array Ultrasound Gastroscope | N/A | ||
Management | MIS (laparoscopic cholecystectomy) with LCBDE | MIS (laparoscopic cholecystectomy) with LCBDE | Anterograde cholangiography, hepatic biopsy | |
Endoscopic Advantages/Limitations | Size limitations; impossibility to perform ERCP |
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Destro, F.; Salerno, R.; Calcaterra, V.; Ardizzone, S.; Meroni, M.; Roveri, M.; Pierucci, U.M.; Zaja, A.; Rizzetto, F.; Campari, A.; et al. Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children. Children 2023, 10, 760. https://doi.org/10.3390/children10040760
Destro F, Salerno R, Calcaterra V, Ardizzone S, Meroni M, Roveri M, Pierucci UM, Zaja A, Rizzetto F, Campari A, et al. Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children. Children. 2023; 10(4):760. https://doi.org/10.3390/children10040760
Chicago/Turabian StyleDestro, Francesca, Raffaele Salerno, Valeria Calcaterra, Sandro Ardizzone, Milena Meroni, Margherita Roveri, Ugo Maria Pierucci, Alberta Zaja, Francesco Rizzetto, Alessandro Campari, and et al. 2023. "Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children" Children 10, no. 4: 760. https://doi.org/10.3390/children10040760
APA StyleDestro, F., Salerno, R., Calcaterra, V., Ardizzone, S., Meroni, M., Roveri, M., Pierucci, U. M., Zaja, A., Rizzetto, F., Campari, A., Vertemati, M., Milani, P., & Pelizzo, G. (2023). Echo-Endoscopy Combined with Virtual Reality: A Whole Perspective of Laparoscopic Common Bile Duct Exploration in Children. Children, 10(4), 760. https://doi.org/10.3390/children10040760