Application of computer-assisted surgery system in a child with multiple traumas: a case report

Severe traumatic liver rupture in children has a high mortality rate. The computer-assisted surgery (CAS) system is an effective medical image simulation tool, which can display the adjacent relationship between the liver and surrounding tissues (especially compressed blood vessels) in a three-dimensional (3D), dynamic and complete way, and assist in precise liver resection. It provides important guidance for preoperative planning and intraoperative navigation. This chapter reports the individualized computer-assisted surgical planning and progress of a case of complex pediatric abdominal trauma.

A 3-year-old girl was admitted to the hospital due to a severe abdominal crush injury caused by a car accident. Contrast-enhanced computed tomography (CT) showed grade V liver injuries [2018 American Association for the Surgery of Trauma-Organ Injury Scale (2018 AAST-OIS)], as well as splenic and renal contusion. Emergency CAS was performed to repair liver contusion. Biliary fluid was drained from the chest cavity after the operation, and contrast-enhanced CT showed diaphragmatic rupture and intrahepatic pseudoaneurysm. The ruptured diaphragm was repaired by laparotomy with the assistance of a Hisense CAS system, and the intrahepatic pseudoaneurysm was treated by interventional therapy. The child responded well to the comprehensive treatment, and no complications such as bile leakage and infection were found after the operation. Regular imaging and laboratory tests confirmed that the child recovered stably, and the child displayed satisfactory physical development and growth during the follow-up period.

The CAS system can predict surgical risk, and has important clinical value for in the treatment of children with multiple traumas.