A case report on the utility of extended reality in selective biliary drainage for hilar cholangiocarcinoma

Abstract

The patient was a 77-year-old man who developed jaundice 2 weeks ago. Abdominal CT revealed the dilatation of the right and left intrahepatic bile ducts caused by hilar cholangiocarcinoma, prompting ERCP. Cholangiography revealed stenosis of the hilar bile duct, but guide wire (GW) seeking to the dilated bile duct was challenging, resulting in the placement of a 5 Fr 8 cm double pigtail stent in the B4a and B4b ducts, respectively. Because the reduction in jaundice after stent placement was minimal, a three-dimensional hologram was created from the Drip Infusion Cholangiography CT image data using Holoeyes MD. This allowed the operator and assistant to stimulate an approach to the left bile duct, leading to repeat ERCP. This time, GW was successfully placed in B8 and B1, with a 5 Fr 8 cm double pigtail stent inserted into each. The use of extended reality appeared beneficial for achieving selective bile duct drainage in patients with hilar cholangiocarcinoma.