Enhancing patient care and safety in complex, high-risk pediatric liver transplant procedures

Innovative mixed reality technology enhances pre-operative planning at the Specialist Paediatric Organ Transplant Centre at NUH, Singapore. Singapore

Singapore, June 5, 2024 /PRNewswire/ — Over the past 30 years, National university hospital (no)Khoo Teck Puat Pediatric Surgery Department – National university Children's Medical Research Institute (KTP-NUCMI) National university The National Center for Organ Transplantation (NUCOT) has worked alongside countless pediatric patients who have bravely overcome obstacles on their road to recovery.

One notable child is Avila, who, at just two years old, has already undergone two major life-saving surgeries.

Less than a month after she was born, Avila was diagnosed with a rare condition called biliary atresia, which causes bile to become trapped in her liver, causing liver damage and scarring that, if left untreated, can eventually lead to liver failure.

Biliary atresia occurs in approximately 1 in 20,000 live births, with a slightly higher prevalence in women.

Overcoming the first hurdle with first-line treatment

Liver transplants have proven to be very effective in the long-term treatment of children with biliary atresia, with an overall survival rate of over 90 percent. However, the initial treatment involves the Kasai procedure, because 50 to 60 percent of children experience significant improvement and have the potential to survive well into old age with their own liver.

So Avila underwent his first Kasai surgery at just two months of age, says surgeon Associate Professor Vidyadhar Malli, Senior Consultant, Department of Pediatric Surgery, KTP-NUCMI. no, The surgeon, surgical director of NUCOT's pediatric kidney and liver transplant program, removed the blocked bile duct outside the liver and attached a loop of small intestine directly to the liver to restore bile flow.

Still, three out of five children may face progressive liver-related complications after the Kasai procedure.

In Avila's case, a follow-up two months after the operation revealed that her liver function had gradually deteriorated, and it was determined that she needed a liver transplant, and her mother, Han, stepped up to be the donor.

Preparing for complex, high-risk surgeries with hybrid mixed reality technology

Preparing for Avira's transplant surgery involved overcoming major challenges.

Liver transplants in small children (weighing less than 10 kg) are relatively rare and considered extremely challenging. Such cases require specialized surgical expertise and careful planning due to the complexities involved in small patients.

Factors such as the child's small size, the need for an appropriately sized liver graft, and the delicate nature of pediatric patients add significant risk and technical difficulty to the surgery.

Avila was so tiny that she needed a feeding tube to help her gain weight in the two months she was born, and her small size meant surgeons had to split up her mother's donated liver (a procedure called a reduction graft) to fit Avila better.

Unlike adults, small children with grafts that are either too large or too small can experience problems after liver transplantation and as the child grows.

Studies have shown that different age- and weight-appropriate approaches and graft size matching strategies are important for better outcomes in pediatric living donor liver transplantation.

In addition to reducing the graft size of the donor liver, the surgical team also needed to determine the exact size of the liver graft needed. Misestimating the graft size could have increased Avira's time on the operating table and increased the risk of graft damage.

To ensure Avila's transplant was the right size, the surgical team, led by Associate Professor/Prof. Mari, employed a hybrid technique that utilised mixed reality imaging (“holomedicine”) to compare a CT scan of the child with that of the donor's liver. This played a key role in accurately estimating the size of Avila's mother's liver in her body pre-operatively.

“Holomedicine utilises mixed reality to interact with virtual objects overlaid on the real world, enabling unparalleled precision in pre-operative planning,” explained Dr Gao Yujia, Consultant in the Hepato-Biliary-Pancreatic Surgery Department of the NUH School of Surgery and Assistant Group Chief Technology Officer who leads the Holomedicine programme. of National university Health System (NUHS).

“This hybrid technology can enhance surgical planning, providing a more accurate and reliable roadmap, improving patient care and safety during surgery,” said Mari, an assistant associate professor.

Little Avila's transplant surgery July 2022 The surgery was successful and both mother and baby have made a full recovery. Today, Avila is a playful, energetic toddler with a bright future, just like most children her age.

NUCOT is Singapore We provide adult and pediatric liver and kidney transplant services in one location, with comprehensive, multidisciplinary medical specialty services needed throughout a patient's transplant journey.

As we celebrate World Transplant Day, we celebrate the courage of every child who receives a transplant and their family. Through continued innovation and compassionate care, NUCOT remains committed to changing lives and providing hope to families navigating the complexities of organ transplantation.

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