ID: 279 (Conflict of Interest: K)

Virtuelle und interaktive 3D-Gefäßrekonstruktion vor geplanter Pankreaskopfresektion und komplexer Gefäßanatomie: Ein bench-to-bedside-Transfer von virtueller Realität

R.Templin, D.Weyhe
Pius-Hospital Oldenburg, Oldenburg


Bühlers' anastomosis (also known as Bühlers‘ arcade) is an embryonic relic and represents an arterio-arterial connection between the superior mesenteric artery and the celiac trunk. It can be found as a variety in 1-2% of patients.


Material und Methoden

We present a case in which a patient with metatastatic squamous cell carcinoma of the lung has been in stable disease for 4 years under palliative therapy (most recently second-line therapy with Nevolumab). In 2019, a locally advanced adenocarcinoma of the papilla vateri was also diagnosed. The patient also had to undergo right hemicolectomy and patch plasty of the celiac trunk and superior mesenteric artery due to colonic ischemia and arteriosclerotic disease with stenosis of the superior mesenteric artery several years ago. For the planning of a pylorus-preserving pancreatic head resection and reconstruction according to Traverso-Longmire, the preoperative imaging was extended by two independent vascular reconstructions due to a complex vascular prehistory.


The Bühler anastomosis was detected in an digital, virtual and interactive 3D-reconstruction. In addition, a 3D print of the abdominal site was made. Both was created as an off-label use as a part of a research project in cooperation with the TZI of the University of Bremen and the Frauenhoferinstitut (VIVATOP: Versatile Immersive Virtual and Augmented Tangible OP). In the actual clinical CT-angiography, this variant had not been described. Intraoperatively, the presence of Bühler's anastomosis was confirmed. However, this information had a significant impact on the intraoperative approach. Retrospectively, this vessel variant could be surmised in the axial projection of the CT scan.


Increasing digitalization in surgical and perioperative preparation, in addition to its special requirements, holds great potential for better planning and improved patient safety. Research and cooperation projects such as the VIVA TOP project are indispensable for this.