Endoscopic biliary drainage by endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant biliary obstruction requires a thorough understanding of the biliary anatomy, as well as accurate identification of the appropriate drainage area. However, achieving this level of understanding in trainee education can be challenging when relying on two-dimensional fluoroscopic images. Mixed reality (MR) is a technology that merges real-world and virtual elements in real time to create an integrated environment . By wearing a dedicated head-mounted display and hand controllers (Meta Quest 3; Meta, USA), users can view holograms, which are computer-generated three-dimensional (3D) graphic models, from their desired perspective ( ). It has been reported that MR with holographic support is feasible for pancreatobiliary endoscopic procedures . We report a case where ERCP was carried out in a patient with hilar bile duct cancer, in which MR-based education with holographic support was feasible.
a.
Mixed-reality-based education with holographic support. A dedicated head-mounted display and hand controllers. b A doctor wearing a head-mounted display and using hand controllers. c A computer-generated three-dimensional (3D) graphic model seen through the head-mounted display. d The 3D model is rotatable.
A 68-year-old man with resectable hilar bile duct cancer was referred to us ( ). After discussion with surgeons, we planned to perform ERCP and biliary drainage of the left intrahepatic bile duct ( ). 3D polygon data of the bile duct was created from computed tomography using Synapse Vincent (Fujifilm Medical Co., Ltd., Japan) and Holoeyes MD software (Holoeyes Inc., Japan) ( ). Before the procedure, trainees received tuition from experts on the patient’s biliary anatomy and the drainage area while using MR with holographic support ( ). Furthermore, they also received tuition while viewing MR alongside fluoroscopic findings during the procedure ( ). Since the MR and fluoroscopic findings were comparable, this helped trainees’ understanding of the procedure. Finally, biliary drainage was performed in the area explained by the experts to the trainees before the procedure using MR.
Computed tomogram showing the biliary stricture caused by bile duct cancer in the hilar bile duct of a 68-year-old man (arrows).
Computed tomographic imaging converted into 3D polygon data.
Before the procedure, trainees received tuition from experts on the patient’s biliary anatomy and the drainage area, using mixed reality with holographic support.
Trainees also received tuition while viewing mixed reality with holographic support alongside fluoroscopic imaging during the procedure.
Mixed-reality-based education with holographic support before and during endoscopic retrograde cholangiopancreatography–related procedures.
MR-based education with holographic support both before and during ERCP was feasible. This approach may represent an innovative educational technology for pancreatobiliary endoscopists.
Endoscopy_UCTN_Code_TTT_1AR_2AB
Footnotes
Conflict of Interest Maki Sugimoto is an employee of Holoeyes, Inc. All other authors declare that they have not had any economic or personal ties as outlined in “Information on possible conflicts of interest” during the past 3 years.
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