THE FIRST EXPERIENCE OF USING AUGMENTED REALITY (AR) TECHNOLOGY IN RECONSTRUCTIVE SURGERY OF THE BILE DUCTS

Methods. A clinical case of surgical treatment of patient P., 39 years old, with a history of surgery in October 2021 for Mirizzi syndrome type 4 is presented. A cholecystectomy was performed with an «end-to-end» anastomosis of the common bile duct on a T-shaped drainage. The postoperative period proceeded without early complications, however, the patient noted the preservation of jaundice of the skin, periodic darkening of urine. A month after the operation, according to magnetic resonance cholangiopancreatography data, an extended stricture from the upper third of the common hepatic duct was revealed. Upon admission to the Saint Petersburg I.I. Dzhanelidze research institute of emergency medicine in February 2022, the patient was fully examined, among the features — the level of total bilirubin was 206.2 mmol/l. The first stage was antegrade biliary decompression by percutaneous transhepatic external drainage of the biliary tract. Subsequently, taking into account the data of multispiral computed tomography-fistulography and multispiral computed tomography of the abdomen, a topographic and anatomical model was built in real time using augmented reality technology. Reconstructive surgery was planned and performed. Among the features, it should be noted a significant reduction in the time for determining and differentiating anatomical vascular and biliary structures in the liver gates against the background of a pronounced adhesive process when using AR. The reconstructive stage ended with the formation of a hepatic-eunoanastomosis on the loop of the small intestine in comparison with an inter-intestinal anastomosis.

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