The Application of Virtual Reality for Preoperative Planning of Lymphovenous Anastomosis in a Patient with a Complex Lymphatic Malformation

Abstract

The management of lymphatic malformations (LMs) is challenging, particularly for large and complex lesions involving anatomical structures in the adjacent tissue. While lymphovenous anastomosis (LVA) has been reported as an effective treatment for lymphedema, it has hardly been described as a treatment for LM. Virtual reality has the ability to visualize human structures in three dimensions and can be used for the preoperative planning of complex cases. Here, we describe the first case of the management of an LM by LVA preoperatively planned with virtual reality. A young woman presented with an LM previously treated by gross excision. Following persistent complaints of swelling, a minimally invasive microsurgical intervention was planned. The results of the single photon emission tomography with computed tomography (SPECT-CT) and lymphoscintigraphy were analyzed using a virtual reality program, and a 3D patient-specific model was constructed. Based on the combined findings of this 3D model and lymphography with a fluorescent marker, a precise skin incision could be determined and one lymph vessel was anastomosed to a nearby vein. The swelling of the thigh reduced and the discomfort disappeared. Although more reports are needed to confirm its efficacy, LVA planned with virtual reality constructed images appears to be a valuable treatment option for complex lesions, including LMs.

Challenges and Strategies for Educational Virtual Reality

“…The general benefits of VR that have been identified are now regularly employed in research capacities across the academy. VR and related 3D data-creation tools are being applied to fields such as digital humanities, 11 archaeology, 12 cultural heritage preservation, 13 medieval studies, 14 HTTPS://DOI.ORG/10.6017/ITAL.V38I4.11075 engineering, 15 biology and biodiversity research, 16 medicine, 17 and architecture. 18 In some cases, these approaches draw on the capabilities of 3D/VR to recreate immersive, high-fidelity experiences of real-world spaces, while in other cases, researchers are exploring the capabilities of VR to provide a platform for analyzing spatially oriented research data in the form of 3D models of cultural heritage artifacts and sites or visualizations of multivariate quantitative data.…”

Surgical Planning of Sacral Nerve Stimulation Procedure in Presence of Sacral Anomalies by Using Personalized Polymeric Prototypes Obtained with Additive Manufacturing Techniques

“…Sharing of these sorts of human models for surgical planning and training through open-source biomedical engineering platforms and collaborative design environments may help to promote the medical impact of these innovative procedures [23] and to progress towards medical device personalization [24]. Exploring connections to virtual surgical planning [25] may open additional continuation lines, especially for patients with malformations, in which virtual planning plays a more relevant role [26].…”

Application of imaging in lymphedema surgical therapies

“…Recent booming computer techniques also provided new aspects in the utility of ICG. Giacalone et al reported a case with lymphatic malformation treated with preoperative virtual reality planning (24). Brebant et al presented an augmented reality intraoperative ICG lymphography navigated LVA (25).…”