Immersive 3D virtual reality imaging in planning minimally invasive and complex adult cardiac surgery

Abstract

Aims Increased complexity in cardiac surgery over the last decades necessitates more precise preoperative planning to minimize operating time, to limit the risk of complications during surgery and to aim for the best possible patient outcome. Novel, more realistic, and more immersive techniques, such as three-dimensional (3D) virtual reality (VR) could potentially contribute to the preoperative planning phase. This study shows our initial experience on the implementation of immersive VR technology as a complementary research-based imaging tool for preoperative planning in cardiothoracic surgery. In addition, essentials to set up and implement a VR platform are described. Methods Six patients who underwent cardiac surgery at the Erasmus Medical Center, Rotterdam, The Netherlands, between March 2020 and August 2020, were included, based on request by the surgeon and availability of computed tomography images. After 3D VR rendering and 3D segmentation of specific structures, the reconstruction was analysed via a head mount display. All participating surgeons (n = 5) filled out a questionnaire to evaluate the use of VR as preoperative planning tool for surgery. Conclusion Our study demonstrates that immersive 3D VR visualization of anatomy might be beneficial as a supplementary preoperative planning tool for cardiothoracic surgery, and further research on this topic may be considered to implement this innovative tool in daily clinical practice. Lay summary Over the past decades, surgery on the heart and vessels is becoming more and more complex, necessitating more precise and accurate preoperative planning. Nowadays, operative planning is feasible on flat, two-dimensional computer screens, however, requiring a lot of spatial and three-dimensional (3D) thinking of the surgeon. Since immersive 3D virtual reality (VR) is an upcoming imaging technique with promising results in other fields of surgery, we aimed in this study to explore the additional value of this technique in heart surgery. Our surgeons planned six different heart operations by visualizing computed tomography scans with a dedicated VR headset, enabling them to visualize the patient’s anatomy in an immersive and 3D environment. The outcomes of this preliminary study are positive, with a much more reality-like simulation for the surgeon. In such, VR could potentially be beneficial as a preoperative planning tool for complex heart surgery.

Virtual reality and artificial intelligence for 3-dimensional planning of lung segmentectomies

“…An immersive VR-based CT (grayscale) DICOM viewer was developed together with MedicalVR. 13 In addition, a dedicated 3D-VR and AI-based pulmonary segmentectomy planning tool called PulmoVR was successfully developed together with MedicalVR, EVOCS Medical Image Communication (Fysicon BV), and Thirona. Segmental anatomy was determined automatically using LungQ software (Thirona).…”

Investigating the Feasibility of Virtual Reality (VR) for Teaching Cardiac Morphology

“…This will help to better understand how and where VR yields the most improvements. Furthermore, the use of VR in medical education should be investigated in other fields, such as for surgical training and interventions [6,19]. Follow-up studies of this kind will help us understand which subsets of clinical training/education are suitable for VR.…”

“…Virtual reality (VR) is a rapidly evolving technology which provides an immersive experience where users can visualise and interact with 3D objects. In the field of CHD, VR can be used to view 3D models when planning complex surgeries [6,7]. The integration of VR in courses for teaching CHD is, however, still in its infancy [8][9][10].…”

Wearable Technology for Assessment and Surgical Assistance in Minimally Invasive Surgery

“…In particular, when facing complex surgeries, surgical planning provides valuable information to predict and reduce any potential risks during surgery, thus improving its safety levels. The application of wearable technology (mainly HMD) in this area provides the surgical team with access to this information in situ and without compromising the asepsis of the surgical procedure [8]. The use of three-dimensional (3D) representations of this data in immersive environments provides new ways to explore the patient information and further enhance the tools available to medical professionals in several areas, such as medical training, surgical planning and intraoperative guidance.…”