Augmented reality navigation combined with indocyanine green fluorescence imaging to assist reconstruction of iatrogenic bile duct injuries: a retrospective single-arm cohort study (with video).

BACKGROUND

Iatrogenic bile duct injuries (IBDIs) remain complex and diverse, presenting significant challenges for preoperative evaluation and surgical repair.

METHODS

Patients who underwent hepaticojejunostomy (HJ) for IBDIs from May 2019 to June 2024 were enrolled. Preoperatively, all patients underwent preoperative individualized 3D modelling of bile duct injury (3DM-BDI) for assessment. During surgery, augmented reality navigation (ARN) combined with indocyanine green fluorescence imaging (ICG-FI) was used for guidance. Perioperative indicators and short-term postoperative outcomes were evaluated to verify the safety and feasibility of this novel approach.

RESULTS

In all patients, the 3DM-BDI accurately predicted the type and extent of bile duct and vascular injuries. The mean operation time was 380.7 ± 83.9 min, and the mean intraoperative blood loss was 135.0 ± 169.7 mL, with no patients requiring intraoperative blood transfusion. The mean postoperative hospital stay was 9.3 ± 2.1 days. The navigation efficiency was 75 % for ICG-FI and 87.5 % for ARN. The success rate of reconstruction was 85.7 % based on follow-up within 90 days.

CONCLUSION

The combination of ARN and ICG-FI as an auxiliary method in the reconstruction of IBDIs may be feasible and safe. These modalities may provide technical advantages in preoperative evaluation and precise dissection of hilar vessels and bile ducts during surgery.