Introduction. Pancreaticoduodenectomy (PD) with superior mesenteric vein (SMV) reconstruction are often required to achieve complete (R0) resection for pancreatic head cancer (PHC) with tumor invasion of the SMV. Augmented reality (AR) technology can be used to assist in determining the extent of SMV involvement by superimposing virtual 3-dimensional (3D) images of the pancreas and regional vasculature on the surgical field. Materials and Methods. Three patients with PHC and tumor invasion of the SMV underwent AR-assisted PD with SMV resection and reconstruction following preoperative computed tomography scanning. Preoperative imaging data were used to reconstruct 3D images of anatomical structures, including the tumor, portal vein (PV), SMV, and splenic vein (SV). Using AR software installed on a smart phone, the reconstructed 3D images were superimposed on the surgical field as viewed in a smart phone display to provide intermittent navigational assistance to the surgeon in identifying the boundaries of PHC tumor invasion for resection of the vessels involved. Result. All patients successfully completed the operation. Intraoperative AR applications displayed virtual images of the pancreas, SMV, bile duct, common hepatic artery (CHA), and superior mesenteric artery (SMA). Two patients required end-to-end anastomosis for reconstruction of the SMV. One patient required allogenic vascular bypass to reconstruct the SMV-PV juncture with concomitant reconstruction of the SV-SMV confluence by end-to-side anastomosis of the SV and bypass vessel. Postoperative pathology confirmed R0 resections for all patients. Conclusion. AR navigation technology based on preoperative CT image data can assist surgeons performing PD with SMV resection and reconstruction.

中文翻译：

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增强现实辅助胰十二指肠切除术联合肠系膜上静脉切除重建

简介。胰十二指肠切除术 (PD) 与肠系膜上静脉 (SMV) 重建通常需要实现完全 (R0) 切除胰腺头癌 (PHC) 的肿瘤侵袭 SMV。增强现实 (AR) 技术可用于通过将胰腺和区域脉管系统的虚拟 3 维 (3D) 图像叠加在手术区域上来帮助确定 SMV 受累的程度。材料和方法. 3 名 PHC 和 SMV 肿瘤侵犯的患者在术前计算机断层扫描后接受了 AR 辅助 PD 和 SMV 切除和重建。术前成像数据用于重建解剖结构的 3D 图像，包括肿瘤、门静脉 (PV)、SMV 和脾静脉 (SV)。使用安装在智能手机上的 AR 软件，将重建的 3D 图像叠加在手术区域上，如智能手机显示屏中所见，为外科医生提供间歇性导航帮助，以识别 PHC 肿瘤侵袭的边界，以切除所涉及的血管。结果. 所有患者均顺利完成手术。术中 AR 应用显示胰腺、SMV、胆管、肝总动脉 (CHA) 和肠系膜上动脉 (SMA) 的虚拟图像。两名患者需要端到端吻合来重建 SMV。一名患者需要异体血管旁路来重建 SMV-PV 接合处，同时通过 SV 和旁路血管的端侧吻合重建 SV-SMV 汇合处。术后病理证实所有患者均进行了 R0 切除。结论。基于术前 CT 图像数据的 AR 导航技术可以帮助外科医生进行 PD 的 SMV 切除和重建。