Application and value of CT-based 3D surgical modeling in the robotic management of grade V pancreatic trauma and grade III duodenal injury: a case report and literature review.

backgroundGrade V pancreatic injury (PI) represents the most severe form of pancreatic trauma, characterized by extensive destruction (including transection) of the pancreatic head, with involvement of the intrapancreatic bile duct, proximal main pancreatic duct, and potentially the duodenal ampulla. Grade III duodenal injury (DI) is defined as a 50%-70% circumferential laceration of the D2 segment. The combination of grade V pancreatic injury and grade III duodenal injury constitutes WSES Class III[1], which typically necessitates surgical intervention. While open surgery remains the standard approach for pediatric patients with hemodynamic instability and ill-defined injury extent, minimally invasive surgery utilizing CT-based three-dimensional surgical model reconstruction technology (CT-3D surgical modeling technology) combined with robotic surgical systems is feasible in hemodynamically stable children with localized injuries following detailed preoperative evaluation. We report the management of a pediatric patient with WSES Class III injury (grade V pancreatic trauma with grade III duodenal trauma), describing the use of three-dimensional (3D) technology for preoperative surgical simulation and subsequent robot-assisted laparoscopic duodenorrhaphy, partial pancreatic head resection, and Roux-en-Y (R-Y) pancreaticojejunostomy. Furthermore, we review the relevant literature and summarize the experience gained from this case. CASE DESCRIPTION: An 8-year-old boy was admitted to our institution one day after a bicycle accident involving handlebar impact to his upper abdomen. Contrast-enhanced CT and MRCP revealed grade V pancreatic injury, grade III duodenal injury (WSES Class III), diffuse peritonitis, and acute pancreatitis. 3D surgical models were constructed using MIMICS and 3D-MATIC software for preoperative simulation, and two surgical contingency plans were formulated. Following preoperative preparation, robot-assisted laparoscopic duodenorrhaphy, partial pancreatic head resection, and R-Y pancreaticojejunostomy were performed. Intraoperative findings corresponded closely with the preoperative simulation. The postoperative course was unremarkable. At one-year follow-up, all parameters remained normal with no duodenal or pancreatic complications, indicating favorable long-term outcomes.

conclusionFor WSES Class III injuries, there is currently no standardized surgical protocol. The operative approach must be individualized based on the extent of injury and the patient's hemodynamic stability. The successful outcome in this case can be attributed to the patient's specific favorable conditions—namely, limited injury without involvement of major vessels, the duodenal papilla, or the biliary tree, along with hemodynamic stability—as well as to our team's accumulated experience in robotic surgery and the integration of CT-3D surgical modeling with the robotic surgical system. Future larger-scale studies are warranted to further explore the applicability and potential benefits of this approach in carefully selected cases.