When endoscopic transpapillary gallbladder drainage (ETGBD) is required, it is challenging
to advance the guidewire into the gallbladder when relying solely on two-dimensional
imaging, such as computed tomography and cholangiography. Mixed reality is a technology
that merges real and virtual environments in real time, creating an immersive and
interactive experience [1]. By utilizing a dedicated head-mounted display and hand controllers (Meta Quest
3; Meta, Menlo Park, California, USA), clinicians can visualize computer-generated
three-dimensional (3D) anatomical models, from any perspective ([Fig. 1]). Several reports have demonstrated the feasibility of mixed-reality-based 3D anatomical
models for pancreaticobiliary endoscopic procedures [2]
[3]
[4]. We present a case of successful guidewire insertion into the gallbladder facilitated
by a mixed-reality-based 3D anatomical model in a patient with acute cholecystitis.
Fig. 1 The mixed-reality-based three-dimensional (3D) anatomical model. a A dedicated head-mounted display and hand controllers. b A doctor wearing a head-mounted display and using hand controllers. c The computer-generated 3D anatomical model as seen through the head-mounted display.
d The 3D anatomical model is rotatable.
A 76-year-old man who presented with acute cholecystitis was referred to us ([Fig. 2]). Owing to his ineligibility for surgery and the presence of coagulopathy, ETGBD
was
selected [5] ([Video 1]). A 3D anatomical model of the biliary system was created using magnetic resonance
imaging with SYNAPSE VINCENT (Fujifilm Medical Co., Tokyo, Japan) and Holoeyes MD
(Holoeyes
Inc., Tokyo, Japan) ([Fig. 3]). Before the procedure, endoscopists reviewed the patient-specific biliary anatomy,
including the confluence of the common bile duct and cystic duct, using the mixed-reality-based
3D anatomical model ([Fig. 4]
a, b). During the procedure, the same model was referenced
alongside the real-time fluoroscopic images ([Fig. 4]
c, d). The mixed-reality-based 3D anatomical model clearly
visualized the anatomical configuration through rotation, which allowed the endoscopists
to
accurately identify the cystic duct and advance the guidewire into the gallbladder
([Fig. 5]
a). ETGBD was completed using a 7-Fr plastic stent ([Fig. 5]
b).
Fig. 2 Magnetic resonance imaging revealed an enlarged gallbladder with wall thickening,
indicating acute cholecystitis (red arrow).
Successful guidewire insertion into the gallbladder facilitated by the mixed-reality-based
three-dimensional anatomical model.Video 1
Fig. 3 Magnetic resonance imaging was converted into a three-dimensional anatomical model.
Fig. 4 Use of the mixed-reality-based three-dimensional (3D) anatomical model. a, b Endoscopists using the model to review the patient-specific
biliary anatomy, including the confluence of the common bile duct and cystic duct,
before
the procedure. c, d Endoscopists referencing the model alongside
the real-time fluoroscopic images during the procedure.
Fig. 5 Guidewire insertion. a Successful guidewire insertion into the gallbladder. b Endoscopic transpapillary gallbladder drainage.
This case highlights the utility of a mixed-reality-based 3D anatomical model in both
preoperative anatomical assessment and intraoperative navigation. The technology provided
enhanced spatial understanding and real-time procedural support, suggesting its potential
as an innovative educational and clinical tool for pancreaticobiliary endoscopists.
Endoscopy_UCTN_Code_TTT_1AR_2AB
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
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by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.