Navigating the biliary maze: a retrospective cohort study of three-dimensional navigation technology improving outcomes in congenital biliary dilatation resection.

Background: Three-dimensional navigation technology (TDNT) has been previously utilized in hepatic and pancreatic surgical procedures, but its application and efficacy in the resection of congenital biliary dilatation (CBD) have not been reported. This study aims to investigate and evaluate the application value of TDNT in the resection of CBD and its short-term outcomes. Methods: Patients who underwent CBD resection surgery from January 2010 to March 2023 were included in this study. Patients were divided into the two groups based on whether TDNT was applied during the operation. After normality assessment via the Shapiro-Wilk test, continuous and categorical variables were compared using the Mann-Whitney U test and the Chi-square/Fisher's exact test, respectively; univariate and multivariable logistic regression were used for risk factor analysis. Results: No significant baseline differences were observed between three-dimensional navigation (TDN) and non-TDN groups (P>0.05). On postoperative day 5 (POD5), TDN group had higher hemoglobin (P=0.008) and shorter drainage (P=0.013). TDN group had lower pancreatic fistula (P=0.025) and bile leakage (P=0.003), but higher blood transfusion (P=0.009). Comprehensive complication index (CCI) proportion was higher (≥26.2) in non-TDN group (P=0.02). Multivariable regression confirmed that TDNT was associated with lower risks of bile leakage [odds ratio (OR) =9.29, P=0.002], pancreatic fistula (OR =10.16, P=0.029), and high CCI (OR =4.50, P=0.026). Conclusions: TDNT in the resection of CBD is a feasible method that is associated with lower rates of postoperative pancreatic fistula and bile leakage. These findings suggest potential benefits in enhancing surgical precision and safety, though prospective studies are needed to establish causality.