To evaluate the clinical application value of three-dimensional (3D) visualization combined with intraoperative ultrasound in D laparoscopic pancreaticoduodenectomy (3D-LPD).

Clinical data of 13 patients who underwent D-LPD in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from July 2020 to March 2021 were retrospectively analyzed. Among them, 8 patients were male and 5 female, aged (60±8) years on average. Preoperative imaging examination showed that the tumors were located in the head of pancreas, the lower part of common bile duct or ampulla. The informed consents of all patients were obtained and the local ethical committee approval was received. The preoperative CT or MRI imaging data were imported into D visualization software for D reconstruction. The location of the tumors was displayed in D patterns. The relationship between the tumors and surrounding tissues and vessels, was accurately determined, and vascular variation was found out, and surgical plan was determined. Intraoperative ultrasound-guided D-LPD was performed.

Preoperative D reconstruction images could explicitly display the relationship between tumors and adjacent tissues and organs, assess the vascular variation, accurately define the resection range and determine the surgical plan. Intraoperative D laparoscopy could achieve deep and stereoscopic sense. Preoperative D reconstruction was consistent with the intraoperative findings. 13 patients successfully completed the operation without conversion to open surgery. The operation time was (405±49) min. Intraoperative blood loss was (109±59) ml. 2 cases developed postoperative grade B pancreatic fistula, which was cured after active drainage. No grade C pancreatic fistula occurred. 1 patient suffered from postoperative abdominal hemorrhage, which was cured after interventional therapy. Postoperative pathological examination indicated all were R0 resection. 11 cases were diagnosed with malignant tumors surrounding the pancreas or ampulla, and 2 cases with benign tumors. All 13 patients were discharged after proper recovery. No death was observed. During 1-8 month follow-up, 1 patient recurred, and the remaining patients lived without tumor recurrence.

D visualization combined with intraoperative ultrasound contributes to preoperative evaluation of tumor size, its relationship with the surrounding tissues and vessels, anatomical variation and accurate intraoperative localization, which can accurately and completely resect the lesions and guarantee the safety in D-LPD.