Application experience and value of CT - based 3D printing technology in surgery rehearsal for grade V pancreatic trauma

Abstract Background： Grade V pancreatic injury, the most severe pancreatic trauma level, involves extensive pancreatic head damage, including disruption of the pancreatic head, intrapancreatic bile duct, proximal main pancreatic duct, and possibly the duodenal ampulla of Vater, typically requiring surgery. For children with unclear injury extent and hemodynamic instability, open surgery is generally performed. However, for those with localized injury and relatively stable hemodynamics, is minimally invasive surgery feasible after rehearsing the surgical procedure with a surgical model? We treated a child with Grade V pancreatic trauma, constructed a surgical model using 3D technology for rehearsal, and performed robot - assisted laparoscopic duodenal repair, partial pancreatectomy of the head, and Roux-en-Y(R-Y) pancreaticojejunostomy. Based on this, we reviewed relevant literature and summarized the surgical experience of this case. Case Description： An 8-year-old boy was admitted to the Guangzhou Medical University Affiliated Women and Children's Medical Center due to "a 1-day history of falling off a bicycle with the handlebar impacting the upper abdomen." After undergoing enhanced CT and MRCP examinations, the patient was diagnosed with Grade V pancreatic injury, duodenal perforation, diffuse peritonitis, and acute pancreatitis, all resulting from a non-traffic-related bicycle accident. We constructed a three-dimensional (3D) surgical model using MIMICS and 3D-Matic software for surgical rehearsal and developed two sets of surgical contingency plans. The next day, we performed a robot-assisted laparoscopic duodenal repair, partial pancreatic head resection, and R-Y pancreaticojejunostomy. Intraoperative findings were largely consistent with the preoperative surgical rehearsal. Postoperative recovery was uneventful, and at the 5-month follow-up, all indicators were normal, indicating favorable long-term outcom. Conclusion： The surgical management of Grade V pancreatic trauma generally comprises damage control, exploration, repair, and gastrointestinal reconstruction. The specific surgical approach requires individualized adaptation based on both the injury extent and the pediatric patient's hemodynamic stability, with staged procedures being necessary in selected cases. CT-based 3D printed anatomical models provide accurate spatial replication of pancreatic lesions, enabling preoperative simulation for robotic surgical system implementation in hemodynamically stable pediatric cases with localized Grade V pancreatic trauma. Current clinical adoption remains limited, and further multicenter experience accumulation is warranted to establish standardized protocols.