Skip to main content
Top
Published in: Surgical Endoscopy 1/2022

Open Access 01-01-2022 | Liver Surgery

IMHOTEP: cross-professional evaluation of a three-dimensional virtual reality system for interactive surgical operation planning, tumor board discussion and immersive training for complex liver surgery in a head-mounted display

Authors: Hannes Götz Kenngott, Micha Pfeiffer, Anas Amin Preukschas, Lisa Bettscheider, Philipp Anthony Wise, Martin Wagner, Stefanie Speidel, Matthias Huber, Felix Nickel, Arianeb Mehrabi, Beat Peter Müller-Stich

Published in: Surgical Endoscopy | Issue 1/2022

Login to get access

Abstract

Background

Virtual reality (VR) with head-mounted displays (HMD) may improve medical training and patient care by improving display and integration of different types of information. The aim of this study was to evaluate among different healthcare professions the potential of an interactive and immersive VR environment for liver surgery that integrates all relevant patient data from different sources needed for planning and training of procedures.

Methods

3D-models of the liver, other abdominal organs, vessels, and tumors of a sample patient with multiple hepatic masses were created. 3D-models, clinical patient data, and other imaging data were visualized in a dedicated VR environment with an HMD (IMHOTEP). Users could interact with the data using head movements and a computer mouse. Structures of interest could be selected and viewed individually or grouped. IMHOTEP was evaluated in the context of preoperative planning and training of liver surgery and for the potential of broader surgical application. A standardized questionnaire was voluntarily answered by four groups (students, nurses, resident and attending surgeons).

Results

In the evaluation by 158 participants (57 medical students, 35 resident surgeons, 13 attending surgeons and 53 nurses), 89.9% found the VR system agreeable to work with. Participants generally agreed that complex cases in particular could be assessed better (94.3%) and faster (84.8%) with VR than with traditional 2D display methods. The highest potential was seen in student training (87.3%), resident training (84.6%), and clinical routine use (80.3%). Least potential was seen in nursing training (54.8%).

Conclusions

The present study demonstrates that using VR with HMD to integrate all available patient data for the preoperative planning of hepatic resections is a viable concept. VR with HMD promises great potential to improve medical training and operation planning and thereby to achieve improvement in patient care.
Appendix
Available only for authorised users
Literature
1.
go back to reference Shin DS, Ingraham CR, Dighe MK, Wang C, Vaidya S, Moshiri M, Lall C, Park JO, Bhargava P (2014) Surgical resection of a malignant liver lesion: what the surgeon wants the radiologist to know. AJR Am J Roentgenol 203:W21-33CrossRef Shin DS, Ingraham CR, Dighe MK, Wang C, Vaidya S, Moshiri M, Lall C, Park JO, Bhargava P (2014) Surgical resection of a malignant liver lesion: what the surgeon wants the radiologist to know. AJR Am J Roentgenol 203:W21-33CrossRef
2.
go back to reference Bramhall SR, Gur U, Coldham C, Gunson BK, Mayer AD, McMaster P, Candinas D, Buckels JA, Mirza DF (2003) Liver resection for colorectal metastases. Ann R Coll Surg Engl 85:334–339CrossRef Bramhall SR, Gur U, Coldham C, Gunson BK, Mayer AD, McMaster P, Candinas D, Buckels JA, Mirza DF (2003) Liver resection for colorectal metastases. Ann R Coll Surg Engl 85:334–339CrossRef
3.
go back to reference Jaeck D, Bachellier P, Guiguet M, Boudjema K, Vaillant JC, Balladur P, Nordlinger B (1997) Long-term survival following resection of colorectal hepatic metastases. Association Francaise de Chirurgie. Br J Surg 84:977–980CrossRef Jaeck D, Bachellier P, Guiguet M, Boudjema K, Vaillant JC, Balladur P, Nordlinger B (1997) Long-term survival following resection of colorectal hepatic metastases. Association Francaise de Chirurgie. Br J Surg 84:977–980CrossRef
4.
go back to reference Fan MH, Chang AE (2002) Resection of liver tumors: technical aspects. Surg Oncol 10:139–152CrossRef Fan MH, Chang AE (2002) Resection of liver tumors: technical aspects. Surg Oncol 10:139–152CrossRef
5.
go back to reference Marz K, Hafezi M, Weller T, Saffari A, Nolden M, Fard N, Majlesara A, Zelzer S, Maleshkova M, Volovyk M, Gharabaghi N, Wagner M, Emami G, Engelhardt S, Fetzer A, Kenngott H, Rezai N, Rettinger A, Studer R, Mehrabi A, Maier-Hein L (2015) Toward knowledge-based liver surgery: holistic information processing for surgical decision support. Int J Comput Assist Radiol Surg 10:749–759CrossRef Marz K, Hafezi M, Weller T, Saffari A, Nolden M, Fard N, Majlesara A, Zelzer S, Maleshkova M, Volovyk M, Gharabaghi N, Wagner M, Emami G, Engelhardt S, Fetzer A, Kenngott H, Rezai N, Rettinger A, Studer R, Mehrabi A, Maier-Hein L (2015) Toward knowledge-based liver surgery: holistic information processing for surgical decision support. Int J Comput Assist Radiol Surg 10:749–759CrossRef
6.
go back to reference Newe A, Becker L, Schenk A (2014) Application and evaluation of interactive 3D PDF for presenting and sharing planning results for liver surgery in clinical routine. PLoS ONE 9:e115697CrossRef Newe A, Becker L, Schenk A (2014) Application and evaluation of interactive 3D PDF for presenting and sharing planning results for liver surgery in clinical routine. PLoS ONE 9:e115697CrossRef
7.
go back to reference Radtke A, Sotiropoulos GC, Molmenti EP, Schroeder T, Peitgen HO, Frilling A, Broering DC, Broelsch CE, Malago M (2010) Computer-assisted surgery planning for complex liver resections: when is it helpful? A single-center experience over an 8-year period. Ann Surg 252:876–883CrossRef Radtke A, Sotiropoulos GC, Molmenti EP, Schroeder T, Peitgen HO, Frilling A, Broering DC, Broelsch CE, Malago M (2010) Computer-assisted surgery planning for complex liver resections: when is it helpful? A single-center experience over an 8-year period. Ann Surg 252:876–883CrossRef
8.
go back to reference Oldhafer KJ, Stavrou GA, Prause G, Peitgen HO, Lueth TC, Weber S (2009) How to operate a liver tumor you cannot see. Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie 394:489–494CrossRef Oldhafer KJ, Stavrou GA, Prause G, Peitgen HO, Lueth TC, Weber S (2009) How to operate a liver tumor you cannot see. Langenbeck’s archives of surgery / Deutsche Gesellschaft fur Chirurgie 394:489–494CrossRef
9.
go back to reference Hallet J, Gayet B, Tsung A, Wakabayashi G, Pessaux P (2015) Systematic review of the use of pre-operative simulation and navigation for hepatectomy: current status and future perspectives. J Hepatobiliary Pancreat Sci 22:353–362CrossRef Hallet J, Gayet B, Tsung A, Wakabayashi G, Pessaux P (2015) Systematic review of the use of pre-operative simulation and navigation for hepatectomy: current status and future perspectives. J Hepatobiliary Pancreat Sci 22:353–362CrossRef
10.
go back to reference Radtke A, Bockhorn M, Schroeder T, Lang H, Paul A, Nadalin S, Saner F, Schenk A, Broelsch CE, Malago M (2006) Computer-assisted planning in living donor liver operation. Zentralbl Chir 131:69–74CrossRef Radtke A, Bockhorn M, Schroeder T, Lang H, Paul A, Nadalin S, Saner F, Schenk A, Broelsch CE, Malago M (2006) Computer-assisted planning in living donor liver operation. Zentralbl Chir 131:69–74CrossRef
11.
go back to reference Kenngott HG, Wagner M, Gondan M, Nickel F, Nolden M, Fetzer A, Weitz J, Fischer L, Speidel S, Meinzer HP, Bockler D, Buchler MW, Muller-Stich BP (2014) Real-time image guidance in laparoscopic liver surgery: first clinical experience with a guidance system based on intraoperative CT imaging. Surg Endosc 28:933–940CrossRef Kenngott HG, Wagner M, Gondan M, Nickel F, Nolden M, Fetzer A, Weitz J, Fischer L, Speidel S, Meinzer HP, Bockler D, Buchler MW, Muller-Stich BP (2014) Real-time image guidance in laparoscopic liver surgery: first clinical experience with a guidance system based on intraoperative CT imaging. Surg Endosc 28:933–940CrossRef
12.
go back to reference Pfeiffer M, Kenngott H, Preukschas A, Huber M, Bettscheider L, Muller-Stich B, Speidel S (2018) IMHOTEP: virtual reality framework for surgical applications. Int J Comput Assist Radiol Surg 13:741–748CrossRef Pfeiffer M, Kenngott H, Preukschas A, Huber M, Bettscheider L, Muller-Stich B, Speidel S (2018) IMHOTEP: virtual reality framework for surgical applications. Int J Comput Assist Radiol Surg 13:741–748CrossRef
13.
go back to reference Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S, Bauer C, Jennings D, Fennessy F, Sonka M, Buatti J, Aylward S, Miller JV, Pieper S, Kikinis R (2012) 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging 30:1323–1341CrossRef Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S, Bauer C, Jennings D, Fennessy F, Sonka M, Buatti J, Aylward S, Miller JV, Pieper S, Kikinis R (2012) 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging 30:1323–1341CrossRef
14.
go back to reference Mise Y, Tani K, Aoki T, Sakamoto Y, Hasegawa K, Sugawara Y, Kokudo N (2013) Virtual liver resection: computer-assisted operation planning using a three-dimensional liver representation. J Hepatobiliary Pancreat Sci 20:157–164CrossRef Mise Y, Tani K, Aoki T, Sakamoto Y, Hasegawa K, Sugawara Y, Kokudo N (2013) Virtual liver resection: computer-assisted operation planning using a three-dimensional liver representation. J Hepatobiliary Pancreat Sci 20:157–164CrossRef
15.
go back to reference Kenngott HG, Wagner M, Nickel F, Wekerle AL, Preukschas A, Apitz M, Schulte T, Rempel R, Mietkowski P, Wagner F, Termer A, Muller-Stich BP (2015) Computer-assisted abdominal surgery: new technologies. Langenbecks Arch Surg 400:273–281CrossRef Kenngott HG, Wagner M, Nickel F, Wekerle AL, Preukschas A, Apitz M, Schulte T, Rempel R, Mietkowski P, Wagner F, Termer A, Muller-Stich BP (2015) Computer-assisted abdominal surgery: new technologies. Langenbecks Arch Surg 400:273–281CrossRef
16.
go back to reference Nickel F, Hendrie JD, Bruckner T, Kowalewski KF, Kenngott HG, Muller-Stich BP, Fischer L (2016) Successful learning of surgical liver anatomy in a computer-based teaching module. Int J Comput Assist Radiol Surg 11:2295–2301CrossRef Nickel F, Hendrie JD, Bruckner T, Kowalewski KF, Kenngott HG, Muller-Stich BP, Fischer L (2016) Successful learning of surgical liver anatomy in a computer-based teaching module. Int J Comput Assist Radiol Surg 11:2295–2301CrossRef
17.
go back to reference Kowalewski KF, Hendrie JD, Schmidt MW, Proctor T, Paul S, Garrow CR, Kenngott HG, Muller-Stich BP, Nickel F (2017) Validation of the mobile serious game application Touch Surgery for cognitive training and assessment of laparoscopic cholecystectomy. Surg Endosc 31:4058–4066CrossRef Kowalewski KF, Hendrie JD, Schmidt MW, Proctor T, Paul S, Garrow CR, Kenngott HG, Muller-Stich BP, Nickel F (2017) Validation of the mobile serious game application Touch Surgery for cognitive training and assessment of laparoscopic cholecystectomy. Surg Endosc 31:4058–4066CrossRef
18.
go back to reference Barsom EZ, Graafland M, Schijven MP (2016) Systematic review on the effectiveness of augmented reality applications in medical training. Surg Endosc 30:4174–4183CrossRef Barsom EZ, Graafland M, Schijven MP (2016) Systematic review on the effectiveness of augmented reality applications in medical training. Surg Endosc 30:4174–4183CrossRef
19.
go back to reference Muller-Stich BP, Lob N, Wald D, Bruckner T, Meinzer HP, Kadmon M, Buchler MW, Fischer L (2013) Regular three-dimensional presentations improve in the identification of surgical liver anatomy - a randomized study. BMC Med Educ 13:131CrossRef Muller-Stich BP, Lob N, Wald D, Bruckner T, Meinzer HP, Kadmon M, Buchler MW, Fischer L (2013) Regular three-dimensional presentations improve in the identification of surgical liver anatomy - a randomized study. BMC Med Educ 13:131CrossRef
20.
go back to reference Jurgaitis J, Paskonis M, Pivoriunas J, Martinaityte I, Juska A, Jurgaitiene R, Samuilis A, Volf I, Schobinger M, Schemmer P, Kraus TW, Strupas K (2008) The comparison of 2-dimensional with 3-dimensional hepatic visualization in the clinical hepatic anatomy education. Medicina (Kaunas) 44:428–438CrossRef Jurgaitis J, Paskonis M, Pivoriunas J, Martinaityte I, Juska A, Jurgaitiene R, Samuilis A, Volf I, Schobinger M, Schemmer P, Kraus TW, Strupas K (2008) The comparison of 2-dimensional with 3-dimensional hepatic visualization in the clinical hepatic anatomy education. Medicina (Kaunas) 44:428–438CrossRef
21.
go back to reference Kowalewski KF, Hendrie JD, Schmidt MW, Garrow CR, Bruckner T, Proctor T, Paul S, Adiguzel D, Bodenstedt S, Erben A, Kenngott H, Erben Y, Speidel S, Muller-Stich BP, Nickel F (2017) Development and validation of a sensor- and expert model-based training system for laparoscopic surgery: the iSurgeon. Surg Endosc 31:2155–2165CrossRef Kowalewski KF, Hendrie JD, Schmidt MW, Garrow CR, Bruckner T, Proctor T, Paul S, Adiguzel D, Bodenstedt S, Erben A, Kenngott H, Erben Y, Speidel S, Muller-Stich BP, Nickel F (2017) Development and validation of a sensor- and expert model-based training system for laparoscopic surgery: the iSurgeon. Surg Endosc 31:2155–2165CrossRef
22.
go back to reference Roberts KE, Bell RL, Duffy AJ (2006) Evolution of surgical skills training. World J Gastroenterol 12:3219–3224CrossRef Roberts KE, Bell RL, Duffy AJ (2006) Evolution of surgical skills training. World J Gastroenterol 12:3219–3224CrossRef
23.
go back to reference Nickel F, Brzoska JA, Gondan M, Rangnick HM, Chu J, Kenngott HG, Linke GR, Kadmon M, Fischer L, Muller-Stich BP (2015) Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices. Medicine (Baltimore) 94:e764CrossRef Nickel F, Brzoska JA, Gondan M, Rangnick HM, Chu J, Kenngott HG, Linke GR, Kadmon M, Fischer L, Muller-Stich BP (2015) Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices. Medicine (Baltimore) 94:e764CrossRef
24.
go back to reference Torjesen I (2015) New 3D virtual human model aims to transform surgical training. BMJ 351:h6071CrossRef Torjesen I (2015) New 3D virtual human model aims to transform surgical training. BMJ 351:h6071CrossRef
25.
go back to reference Graafland M, Schraagen JM, Schijven MP (2012) Systematic review of serious games for medical education and surgical skills training. Br J Surg 99:1322–1330CrossRef Graafland M, Schraagen JM, Schijven MP (2012) Systematic review of serious games for medical education and surgical skills training. Br J Surg 99:1322–1330CrossRef
26.
go back to reference Soler L, Marescaux J (2008) Patient-specific surgical simulation. World J Surg 32:208–212CrossRef Soler L, Marescaux J (2008) Patient-specific surgical simulation. World J Surg 32:208–212CrossRef
27.
go back to reference Condino S, Carbone M, Ferrari V, Faggioni L, Peri A, Ferrari M, Mosca F (2011) How to build patient-specific synthetic abdominal anatomies. An innovative approach from physical toward hybrid surgical simulators. Int J Med Robot 7:202–213CrossRef Condino S, Carbone M, Ferrari V, Faggioni L, Peri A, Ferrari M, Mosca F (2011) How to build patient-specific synthetic abdominal anatomies. An innovative approach from physical toward hybrid surgical simulators. Int J Med Robot 7:202–213CrossRef
28.
go back to reference Rampone B, Schiavone B, Confuorto G (2010) Current management of hepatocellular cancer. Curr Oncol Rep 12:186–192CrossRef Rampone B, Schiavone B, Confuorto G (2010) Current management of hepatocellular cancer. Curr Oncol Rep 12:186–192CrossRef
29.
go back to reference Johnston AN, Hamill J, Barton MJ, Baldwin S, Percival J, Williams-Pritchard G, Salvage-Jones J, Todorovic M (2015) Student learning styles in anatomy and physiology courses: meeting the needs of nursing students. Nurse Educ Pract 15:415–420CrossRef Johnston AN, Hamill J, Barton MJ, Baldwin S, Percival J, Williams-Pritchard G, Salvage-Jones J, Todorovic M (2015) Student learning styles in anatomy and physiology courses: meeting the needs of nursing students. Nurse Educ Pract 15:415–420CrossRef
30.
go back to reference Glaser B, Schellenberg T, Koch L, Hofer M, Modemann S, Dubach P, Neumuth T (2016) Design and evaluation of an interactive training system for scrub nurses. Int J Comput Assist Radiol Surg 11:1527–1536CrossRef Glaser B, Schellenberg T, Koch L, Hofer M, Modemann S, Dubach P, Neumuth T (2016) Design and evaluation of an interactive training system for scrub nurses. Int J Comput Assist Radiol Surg 11:1527–1536CrossRef
31.
go back to reference Garrett B, Taverner T, Gromala D, Tao G, Cordingley E, Sun C (2018) Virtual reality clinical research: promises and challenges. JMIR Serious Games 6:e10839CrossRef Garrett B, Taverner T, Gromala D, Tao G, Cordingley E, Sun C (2018) Virtual reality clinical research: promises and challenges. JMIR Serious Games 6:e10839CrossRef
32.
go back to reference Barrett J (2004) Side effects of virtual environments: a review of the literature Barrett J (2004) Side effects of virtual environments: a review of the literature
33.
go back to reference Islam MM, Poly TN, Li YJ (2018) Recent advancement of clinical information systems: opportunities and challenges. Yearb Med Inform 27:83–90CrossRef Islam MM, Poly TN, Li YJ (2018) Recent advancement of clinical information systems: opportunities and challenges. Yearb Med Inform 27:83–90CrossRef
34.
go back to reference Evans RS (2016) Electronic health records: then, now, and in the future. Yearb Med Inform Suppl 1:S48-61 Evans RS (2016) Electronic health records: then, now, and in the future. Yearb Med Inform Suppl 1:S48-61
35.
go back to reference Norrby M, Grebner C, Eriksson J, Bostrom J (2015) Molecular rift: virtual reality for drug designers. J Chem Inf Model 55:2475–2484CrossRef Norrby M, Grebner C, Eriksson J, Bostrom J (2015) Molecular rift: virtual reality for drug designers. J Chem Inf Model 55:2475–2484CrossRef
Metadata
Title
IMHOTEP: cross-professional evaluation of a three-dimensional virtual reality system for interactive surgical operation planning, tumor board discussion and immersive training for complex liver surgery in a head-mounted display
Authors
Hannes Götz Kenngott
Micha Pfeiffer
Anas Amin Preukschas
Lisa Bettscheider
Philipp Anthony Wise
Martin Wagner
Stefanie Speidel
Matthias Huber
Felix Nickel
Arianeb Mehrabi
Beat Peter Müller-Stich
Publication date
01-01-2022
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 1/2022
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-08246-4

Other articles of this Issue 1/2022

Surgical Endoscopy 1/2022 Go to the issue