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Surgical Endoscopy
Published in: Surgical Endoscopy 5/2024

Open Access 08-03-2024 | Liver Surgery

Comparing a virtual reality head-mounted display to on-screen three-dimensional visualization and two-dimensional computed tomography data for training in decision making in hepatic surgery: a randomized controlled study

Authors: Anas Amin Preukschas, Philipp Anthony Wise, Lisa Bettscheider, Micha Pfeiffer, Martin Wagner, Matthias Huber, Mohammad Golriz, Lars Fischer, Arianeb Mehrabi, Fabian Rössler, Stefanie Speidel, Thilo Hackert, Beat Peter Müller-Stich, Felix Nickel, Hannes Götz Kenngott

Published in: Surgical Endoscopy | Issue 5/2024

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Abstract

Objective

Evaluation of the benefits of a virtual reality (VR) environment with a head-mounted display (HMD) for decision-making in liver surgery.

Background

Training in liver surgery involves appraising radiologic images and considering the patient’s clinical information. Accurate assessment of 2D-tomography images is complex and requires considerable experience, and often the images are divorced from the clinical information. We present a comprehensive and interactive tool for visualizing operation planning data in a VR environment using a head-mounted-display and compare it to 3D visualization and 2D-tomography.

Methods

Ninety medical students were randomized into three groups (1:1:1 ratio). All participants analyzed three liver surgery patient cases with increasing difficulty. The cases were analyzed using 2D-tomography data (group “2D”), a 3D visualization on a 2D display (group “3D”) or within a VR environment (group “VR”). The VR environment was displayed using the “Oculus Rift ™” HMD technology. Participants answered 11 questions on anatomy, tumor involvement and surgical decision-making and 18 evaluative questions (Likert scale).

Results

Sum of correct answers were significantly higher in the 3D (7.1 ± 1.4, p < 0.001) and VR (7.1 ± 1.4, p < 0.001) groups than the 2D group (5.4 ± 1.4) while there was no difference between 3D and VR (p = 0.987). Times to answer in the 3D (6:44 ± 02:22 min, p < 0.001) and VR (6:24 ± 02:43 min, p < 0.001) groups were significantly faster than the 2D group (09:13 ± 03:10 min) while there was no difference between 3D and VR (p = 0.419). The VR environment was evaluated as most useful for identification of anatomic anomalies, risk and target structures and for the transfer of anatomical and pathological information to the intraoperative situation in the questionnaire.

Conclusions

A VR environment with 3D visualization using a HMD is useful as a surgical training tool to accurately and quickly determine liver anatomy and tumor involvement in surgery.
Appendix
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Literature
1.
Shin DS, Ingraham CR, Dighe MK, Wang C, Vaidya S, Moshiri M et al (2014) Surgical resection of a malignant liver lesion: what the surgeon wants the radiologist to know. Am J Roentgenol 203(1):W21–W33PubMedCrossRef
2.
Bramhall SR, Gur U, Coldham C, Gunson BK, Mayer AD, McMaster P et al (2003) Liver resection for colorectal metastases. Ann R Coll Surg Engl 85(5):334–339PubMedPubMedCentralCrossRef
3.
Jaeck D, Bachellier P, Guiguet M, Boudjema K, Vaillant JC, Balladur P et al (1997) Long-term survival following resection of colorectal hepatic metastases. Association Francaise de Chirurgie. Br J Surg 84(7):977–980PubMedCrossRef
4.
Gobel T, Graf D, Hosnowsky C, Blondin D, Knoefel WT, Haussinger D et al (2017) Multimodal and sequential treatment improves survival in patients with hepatocellular carcinoma. Z Gastroenterol 55(3):251–259PubMed
5.
Morise Z (2019) Developments and perspectives of laparoscopic liver resection in the treatment of hepatocellular carcinoma. Surg Today 49(8):649–655PubMedCrossRef
6.
Gobel T, Blondin D, Kolligs F, Bolke E, Erhardt A (2013) Current therapy of hepatocellular carcinoma with special consideration of new and multimodal treatment concepts. Dtsch Med Wochenschr 138(27):1425–1430PubMed
7.
8.
Simo KA, Halpin LE, McBrier NM, Hessey JA, Baker E, Ross S et al (2016) Multimodality treatment of intrahepatic cholangiocarcinoma: a review. J Surg Oncol 13(1):62–83CrossRef
9.
Weiss MJ, Cosgrove D, Herman JM, Rastegar N, Kamel I, Pawlik TM (2014) Multimodal treatment strategies for advanced hilar cholangiocarcinoma. Langenbecks Arch Surg 399(6):679–692PubMedCrossRef
10.
Sheikh MR, Osman H, Butt MU, Jeyarajah DR (2016) Perception of training in hepatopancreatobiliary surgery among general surgery residents in the Americas. HPB (Oxford) 18(12):1039–1045PubMedCrossRef
11.
Friedell ML, VanderMeer TJ, Cheatham ML, Fuhrman GM, Schenarts PJ, Mellinger JD et al (2014) Perceptions of graduating general surgery chief residents: are they confident in their training? J Am Coll Surg 218(4):695–703PubMedCrossRef
12.
Marz K, Hafezi M, Weller T, Saffari A, Nolden M, Fard N et al (2015) Toward knowledge-based liver surgery: holistic information processing for surgical decision support. Int J Comput Assist Radiol Surg 10(6):749–759PubMedCrossRef
13.
Rampone B, Schiavone B, Confuorto G (2010) Current management of hepatocellular cancer. Curr Oncol Rep 12(3):186–192PubMedCrossRef
14.
Morise Z, Kawabe N, Tomishige H, Nagata H, Kawase J, Arakawa S et al (2014) Recent advances in liver resection for hepatocellular carcinoma. Front Surg 1:21PubMedPubMedCentralCrossRef
15.
Soares KC, Kamel I, Cosgrove DP, Herman JM, Pawlik TM (2014) Hilar cholangiocarcinoma: diagnosis, treatment options, and management. Hepatobiliary Surg Nutr 3(1):18–34PubMedPubMedCentral
16.
Radtke A, Sotiropoulos GC, Molmenti EP, Schroeder T, Peitgen HO, Frilling A et al (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(5):876–883PubMedCrossRef
17.
Oldhafer KJ, Stavrou GA, Prause G, Peitgen HO, Lueth TC, Weber S (2009) How to operate a liver tumor you cannot see. Langenbeck’s Arch Surg 394(3):489–494CrossRef
18.
Hallet J, Gayet B, Tsung A, Wakabayashi G, Pessaux P, International Consensus Conference on Laparoscopic Liver Resection Group (2015) Systematic review of the use of pre-operative simulation and navigation for hepatectomy: current status and future perspectives. J Hepatobiliary Pancreat Sci 22(5):353–362PubMedCrossRef
19.
Mise Y, Tani K, Aoki T, Sakamoto Y, Hasegawa K, Sugawara Y et al (2013) Virtual liver resection: computer-assisted operation planning using a three-dimensional liver representation. J Hepatobiliary Pancreat Sci 20(2):157–164PubMedCrossRef
20.
Nickel F, Hendrie JD, Bruckner T, Kowalewski KF, Kenngott HG, Muller-Stich BP et al (2016) Successful learning of surgical liver anatomy in a computer-based teaching module. Int J Comput Assist Radiol Surg 11(12):2295–2301PubMedCrossRef
21.
Monch J, Muhler K, Hansen C, Oldhafer KJ, Stavrou G, Hillert C et al (2013) The LiverSurgeryTrainer: training of computer-based planning in liver resection surgery. Int J Comput Assist Radiol Surg 8(5):809–818PubMedCrossRef
22.
23.
Metzler R, Stein D, Tetzlaff R, Bruckner T, Meinzer HP, Buchler MW et al (2012) Teaching on three-dimensional presentation does not improve the understanding of according CT images: a randomized controlled study. Teach Learn Med 24(2):140–148PubMedCrossRef
24.
Beermann J, Tetzlaff R, Bruckner T, Schoebinger M, Muller-Stich BP, Gutt CN et al (2010) Three-dimensional visualisation improves understanding of surgical liver anatomy. Med Educ 44(9):936–940PubMedCrossRef
25.
Jurgaitis J, Paskonis M, Pivoriunas J, Martinaityte I, Juska A, Jurgaitiene R et al (2008) The comparison of 2-dimensional with 3-dimensional hepatic visualization in the clinical hepatic anatomy education. Medicina (Kaunas) 44(6):428–438PubMedCrossRef
26.
Radtke A, Bockhorn M, Schroeder T, Lang H, Paul A, Nadalin S et al (2006) Computer-assisted planning in living donor liver operation. Zentralbl Chir 131(1):69–74PubMedCrossRef
27.
Kenngott HG, Wagner M, Gondan M, Nickel F, Nolden M, Fetzer A et al (2014) Real-time image guidance in laparoscopic liver surgery: first clinical experience with a guidance system based on intraoperative CT imaging. Surg Endosc 28(3):933–940PubMedCrossRef
28.
29.
Condino S, Carbone M, Ferrari V, Faggioni L, Peri A, Ferrari M et al (2011) How to build patient-specific synthetic abdominal anatomies. An innovative approach from physical toward hybrid surgical simulators. Int J Med Robot 7(2):202–213PubMedCrossRef
30.
31.
Kowalewski KF, Garrow CR, Schmidt MW, Benner L, Muller-Stich BP, Nickel F (2019) Sensor-based machine learning for workflow detection and as key to detect expert level in laparoscopic suturing and knot-tying. Surg Endosc 33:3732PubMedCrossRef
32.
Kowalewski KF, Hendrie JD, Schmidt MW, Garrow CR, Bruckner T, Proctor T et al (2017) Development and validation of a sensor- and expert model-based training system for laparoscopic surgery: the iSurgeon. Surg Endosc 31(5):2155–2165PubMedCrossRef
33.
Kenngott HG, Wunscher JJ, Wagner M, Preukschas A, Wekerle AL, Neher P et al (2015) OpenHELP (Heidelberg laparoscopy phantom): development of an open-source surgical evaluation and training tool. Surg Endosc 29(11):3338–3347PubMedPubMedCentralCrossRef
34.
Nickel F, Brzoska JA, Gondan M, Rangnick HM, Chu J, Kenngott HG et al (2015) Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices. Medicine (Baltimore) 94(20):e764PubMedCrossRef
35.
Schmidt MW, Kowalewski KF, Schmidt ML, Wennberg E, Garrow CR, Paik S et al (2019) The Heidelberg VR Score: development and validation of a composite score for laparoscopic virtual reality training. Surg Endosc 33(7):2093–2103PubMedCrossRef
36.
Viglialoro R, Esposito N, Condino S, Cutolo F, Guadagni S, Gesi M et al (2018) Augmented reality to improve surgical simulation. Lessons learned towards the design of a hybrid laparoscopic simulator for cholecystectomy. IEEE Trans Biomed Eng 7:2091
37.
Barsom EZ, Graafland M, Schijven MP (2016) Systematic review on the effectiveness of augmented reality applications in medical training. Surg Endosc 30(10):4174–4183PubMedPubMedCentralCrossRef
38.
Mersmann S, Seitel A, Erz M, Jahne B, Nickel F, Mieth M et al (2013) Calibration of time-of-flight cameras for accurate intraoperative surface reconstruction. Med Phys 40(8):082701PubMedCrossRef
39.
Kenngott HG, Wagner M, Nickel F, Wekerle AL, Preukschas A, Apitz M et al (2015) Computer-assisted abdominal surgery: new technologies. Langenbecks Arch Surg 400(3):273–281PubMedCrossRef
40.
Friedrich M, Bergdolt C, Haubruck P, Bruckner T, Kowalewski KF, Muller-Stich BP et al (2017) App-based serious gaming for training of chest tube insertion: study protocol for a randomized controlled trial. Trials 18(1):56PubMedPubMedCentralCrossRef
41.
Kenngott HG, Pfeiffer M, Preukschas AA, Bettscheider L, Wise PA, Wagner M et al (2022) 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. Surg Endosc 36(1):126–134PubMedCrossRef
42.
43.
Hollander JE, Carr BG (2020) Virtually perfect? Telemedicine for Covid-19. New Engl J Med 382(18):1679–1681PubMedCrossRef
44.
45.
Pfeiffer M, Kenngott H, Preukschas A, Huber M, Bettscheider L, Muller-Stich B et al (2018) IMHOTEP: virtual reality framework for surgical applications. Int J Comput Assist Radiol Surg 13(5):741–748PubMedCrossRef
46.
Vadala G, De Salvatore S, Ambrosio L, Russo F, Papalia R, Denaro V (2020) Robotic spine surgery and augmented reality systems: a state of the art. Neurospine 17(1):88–100PubMedPubMedCentralCrossRef
47.
Lee D, Yu HW, Kim S, Yoon J, Lee K, Chai YJ et al (2020) Vision-based tracking system for augmented reality to localize recurrent laryngeal nerve during robotic thyroid surgery. Sci Rep 10(1):8437PubMedPubMedCentralCrossRef
48.
Lave A, Meling TR, Schaller K, Corniola MV (2020) Augmented reality in intracranial meningioma surgery: a case report and systematic review. J Neurosurg Sci 64:369PubMedCrossRef
49.
Hussain R, Lalande A, Guigou C, Bozorg-Grayeli A (2020) Contribution of augmented reality to minimally invasive computer-assisted cranial base surgery. IEEE J Biomed Health Inform 24(7):2093–2106PubMed
50.
51.
Rizzetto F, Bernareggi A, Rantas S, Vanzulli A, Vertemati M (2020) Immersive virtual reality in surgery and medical education: diving into the future. Am J Surg 4:856CrossRef
52.
Barber SR, Jain S, Mooney MA, Almefty KK, Lawton MT, Son YJ et al (2020) Combining stereoscopic video and virtual reality simulation to maximize education in lateral skull base surgery. Otolaryngol Head Neck Surg 162(6):922–925PubMedCrossRef
53.
Graafland M, Schraagen JM, Schijven MP (2012) Systematic review of serious games for medical education and surgical skills training. Br J Surg 99(10):1322–1330PubMedCrossRef
54.
Mohammad WM, Martel G, Mimeault R, Fairfull-Smith RJ, Auer RC, Balaa FK (2012) Evaluating agreement regarding the resectability of colorectal liver metastases: a national case-based survey of hepatic surgeons. HPB (Oxford) 14(5):291–297PubMedCrossRef
55.
Mylopoulos M, Regehr G, Ginsburg S (2011) Exploring residents’ perceptions of expertise and expert development. Acad Med 86(10 Suppl):S46–S49PubMedCrossRef
56.
Haubruck P, Nickel F, Ober J, Walker T, Bergdolt C, Friedrich M et al (2018) Evaluation of app-based serious gaming as a training method in teaching chest tube insertion to medical students: randomized controlled trial. J Med Internet Res 20(5):e195PubMedPubMedCentralCrossRef
57.
Kowalewski KF, Hendrie JD, Schmidt MW, Proctor T, Paul S, Garrow CR et al (2017) Validation of the mobile serious game application Touch Surgery for cognitive training and assessment of laparoscopic cholecystectomy. Surg Endosc 31(10):4058–4066PubMedCrossRef
58.
Nickel F, Bintintan VV, Gehrig T, Kenngott HG, Fischer L, Gutt CN et al (2013) Virtual reality does not meet expectations in a pilot study on multimodal laparoscopic surgery training. World J Surg 37(5):965–973PubMedCrossRef
59.
60.
Saredakis D, Szpak A, Birckhead B, Keage HAD, Rizzo A, Loetscher T (2020) Factors associated with virtual reality sickness in head-mounted displays: a systematic review and meta-analysis. Front Hum Neurosci 14:96PubMedPubMedCentralCrossRef
61.
62.
63.
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(12):e115697PubMedPubMedCentralCrossRef
64.
65.
Dorsey ER, Topol EJ (2020) Telemedicine 2020 and the next decade. Lancet (London, England) 395(10227):859PubMedCrossRef
66.
Zhang J, Gao F, Ye Z (2020) Remote consultation based on mixed reality technology. Global Health J 4(1):31–32CrossRef
67.
Li J, Chen G, Ridder HD, Cesar P (2020) Designing a social VR clinic for medical consultations. Extended abstracts of the 2020 CHI conference on human factors in computing systems. Association for Computing Machinery, Honolulu, pp 1–9
68.
Moglia A, Ferrari V, Morelli L, Ferrari M, Mosca F, Cuschieri A (2016) A systematic review of virtual reality simulators for robot-assisted surgery. Eur Urol 69:1065PubMedCrossRef
69.
Kim H-J, Jo Y-J, Choi J-S, Kim H-J, Park I-S, You J-S et al (2020) Virtual reality simulation and augmented reality-guided surgery for total maxillectomy: a case report. Appl Sci 10(18):6288CrossRef
Metadata
Title
Comparing a virtual reality head-mounted display to on-screen three-dimensional visualization and two-dimensional computed tomography data for training in decision making in hepatic surgery: a randomized controlled study
Authors
Anas Amin Preukschas
Philipp Anthony Wise
Lisa Bettscheider
Micha Pfeiffer
Martin Wagner
Matthias Huber
Mohammad Golriz
Lars Fischer
Arianeb Mehrabi
Fabian Rössler
Stefanie Speidel
Thilo Hackert
Beat Peter Müller-Stich
Felix Nickel
Hannes Götz Kenngott
Publication date
08-03-2024
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 5/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-023-10615-8

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