V12-10: Initial Experience with Virtual Reality Enhanced Partial Nephrectomy
For over half a century surgeons have used axial imaging in the form of two-dimensional computed tomography (CT) or magnetic resonance (MR) imaging for pre-operative planning. Despite this robust clinical experience, surgeons do not always have a precise understanding of the final surgical anatomy. Virtual reality (VR) models allow surgeons to immerse themselves and manipulate a three-dimensional (3D) representation of the anatomy. We compared standard axial imaging to VR immersion and anatomical engagement for anatomic understanding.
Patients undergoing partial nephrectomy (PN) for tumor were identified. Standard axial non-contrast and contrast CT and/or MR images of the patient (in DICOM file format) were used to create computer-assisted designs (CAD) of the kidney using 3D Splicer 4.8 software. Subsequently, for virtual model creation, these CAD designs were uploaded to a VR program (Bosc) for use with the Oculus Rift and Touch (a commercially available head-mounted display) and Leap Motion. The virtual model of the entire kidney and the relevant anatomy was segmented into separate anatomic parts. Surgeons recorded their responses on a Likert-type scale (scale = 1 strongly disagree to 5 strongly agree) for their pre-and post-operative experience with the VR technology.
Ten patients managed by three experienced surgeons were recruited for VR model creation. On the pre-operative questionnaire, physicians strongly agreed that the VR model improved their understanding and confidence in the surgery (4.9/5), VR is a valuable surgical tool (4.9/5), and that they would use it for future surgery (4.9/5), recommend it to their colleagues (4.9/5) and use it to teach residents (4.9/5). On the post-operative questionnaire, surgeons indicated that the VR rendering helped navigate the anatomy (4.7/5), it correlated with the hilar anatomy (4.3/5), collecting system (4.6/5), vasculature (4.4/5), mass size and location (4.8/5). In addition, the VR models modified the operative approach 40% (4/10) of the time (Table 1).
In this initial experience, the interactive VR models provide accurate and improved understanding of the pertinent anatomy.