How often does VR change the surgical plan?

“In MTB, 1 of 20 decisions (5%) was modified after 3D review”

5%

“Modelling may help evaluate transcatheter pulmonary valve replacement candidacy, but must be used in conjunction with other data.”

“Compared to conventional imaging, preoperative VR simulations modified the surgical approach in 75.0% of cases”

75.0%

“The high depth perception and precision in the orientation of the arteries and veins to the parenchyma changed the intraoperative decision-making process in five patients.”

“Image presentation using VR significantly influenced the recommended surgical therapies (decompression only/decompression and fusion; p = 0.02), had no significant influence on the recommended fusion method (rigid/dynamic/stand-alone; p = 0.77)”

p = 0.02

“The 3D-VR modality significantly influenced the detection of tumor-related anatomical structures (p = 0.002), recommended head positioning (p = 0.005), and surgical approach (p = 0.03).”

p = 0.005

“After viewing patient cases on VR, surgeons reported that they would have made minor modifications to surgical approach in 53% and major modifications in 7% of cases.”

53%

“In addition, surgical planning was improved since new observations or different preoperative plans were apparent in 4 out of 7 cases.”

4 out of 7

“Image presentation using VR had a significant influence on the recommended surgical approach (P = 0.02), but no influence on the recommended patient positioning (P = 0.37) or placement of craniotomy (P = 0.09).”

P = 0.02

“The 3D-VR modality significantly influenced detection of the aneurysm-related vascular structure (p = 0.0001), the recommended head positioning (p = 0.005), and the surgical approach (p = 0.001) in the planning of microsurgical clipping.”

p = 0.001

“Reconstruction of pre- and postoperative 2D-CT images of the cervical spine into 3D images, and the spatial and anatomical reconstructions in VR models, can be helpful in planning surgical approaches and treatment strategies for patients with cervical foraminal stenoses”

“Among surgeons and interventionalists, 82% reported improved procedural planning and 57% altered their procedural approach.”

57%

“All participants agreed that the VR representation matched PACS CT imaging, and 87% reported a change in operative plan.”

87%

“Users reported they would change the surgical approach or margins 44.4 % of the time after reviewing with VR technology.”

44.4 %

“Skull position significantly changed in 5 out of 6 cases after 3D-AR view (P < 0.05, 20° angular adjustment).”

5 out of 6 cases

“The operative plan changed 8.3% of the time after VRM.”

8.3%

“In addition, the intended patient positioning changed in 16.1% of the cases, the surgical approach in 33.9% and osteosynthesis in 39.3%.”

33.9%

“Possible change in treatment was reported using 3D-Print in 33%, VR-Glasses in 44%, and 3D-Display in 33% of participants.”

44%

“64.4% and 44.4% of the surgeons changed their clamping and resection approach”

64.4% and 44.4%

“While XR technologies improved surgeon confidence and altered surgical strategies in several cases, most studies were small and single-center feasibility evaluations.”

“VR was the most utilized technology (17 studies), improving spatial understanding and prompting plan modifications in 32%-52% of cases (e.g., lung segmentectomies, TAVR).”

32%-52%

“a research group of pediatric cardiac surgeons reported increased confidence when planning and performing surgeries in two-thirds of cases and improvements in the surgical strategy in 60% of cases [38].”

60% of cases

“The increasing use of such innovative technologies has completely changed the way to approach a lesion, using 3D visualization to foster a better understanding of its anatomical and vascular characteristics.”

“Notably, surgical planning using VR led to more frequent changes in surgical plans compared to planning with other visualization methods when surgeons reassessed their initial plans.”

“Preoperative VR planning significantly influenced surgical recommendations…”

“A positive impact on surgical planning was documented by 19 studies (67.9%)…”

67.9%

“In cranial surgery, VR has excelled in helping neurosurgeons design unique patient-specific approaches to particularly challenging tumor excisions.”

“The integrated simulation reshaped the multistep approach, allowing venous partition strategies and refined cranial reconstruction planning to be discussed, replicated, and enhanced multidisciplinarily.”

“model simulated a virtual biventricular repair and demonstrated inadequate outflow tracts after patching and baffle”

“As the VR reconstructions had suggested an irregular shape of the orifices earlier, the detection of residual flows above the caudally placed muscular VSD device immediately allowed us to switch to plan B, using a sandwich between two occluders”

“AR/VR planning changed the procedural approach in 23 of 50 cases (46%).”

23 of 50 cases (46%)

“AR/VR planning represented 3.6% of case time and was perceived to change the approach in 6/8 cases (75%).”

6/8 cases (75%)

“However, because routine empirical ablation of the left PV carina is not part of our standard strategy, this finding did not lead to a predefined modification of the initial ablation plan.”

“The incision site marking made using HoloLens® 2 differed by one intercostal space from the marking made using a conventional surgeon's mental reconstructed image from the patient's preoperative imaging and was found to be a more appropriate site of entry”

“This technological setup was employed for pre-operative and intraoperative planning and further enhanced clinical decision-making for the actual tumor resection.”

“In Patient 1, virtual reality simulation revealed that, according to the distance and angulation from the annulus, the ideal puncture site was the second intercostal space.”

“Initial surgical planning favored an anterior approach, but VR-assisted mapping demonstrated that a posterior approach would provide greater exposure while minimizing disruption to surrounding structures”

“This allowed the robotic surgeon to plan their detailed surgical approach (two-step excision) and perform the surgery efficiently and effectively, achieving an optimal surgical outcome and minimal surgical complications.”

“A preliminary brachytherapy treatment plan was generated in Oncentra, incorporating the VR-based findings.”

“The multi-layered and 3D model of the ST system facilitates epilepsy decision-making for both diagnosis and treatment, enhances surgical navigation, and even allows, in a robust virtual reality (VR) environment, the practice of complex surgical procedures.”

“was initially considered for the single-ventricle pathway. However, preoperative evaluation using a holographic workstation enabled precise ventricular volume assessment and intraventricular rerouting simulation. A virtual baffle confirmed the feasibility of biventricular repair.”

“Based on the preoperative assessment, it was decided to perform a femoral–deep femoral artery bypass. Due to coral reef aorta, aortic surgery was excluded”

“This allowed the surgeon to plan the craniotomy location and optimize proper head position.”

“which were useful to plan valve implantation with a modified technique”

“Virtual reality imaging aided visualisation, decision-making, and planning.”

“Processed images and virtual reality showed intense adherences of the leads to the veins, right ventricle, and right atrium endocardium and between them that preclude a difficult extraction and required a carefully planning and sometimes a different technical approach.”

“This process revealed that the conventional port site located directly below the costal arch for laparoscopic nephrectomy was near the tumor. Therefore, the port site was set 1.5 cm caudal to this location”

“We can utilize VR/AR technologies to identify patients that will benefit from an SOKC and expand the implementation of the approach beyond its current limitations.”

“Participants found that "data visualization" and "clinical decision-making" were effective in IVR: median 5 (interquartile range [IQR], 4-5) and 5 (IQR, 4-5), respectively.”

“In four cases, VR imaging modified the surgical strategy…”

“The results could be visualized by mixed reality devices to further enhance surgical decision-making.”

“In the cases presented, the final approach decided for each patient after 3D-based planning was improved when compared to the intention to treat recorded before 3D-based planning.”

“The application of advanced 3D visualization with a novel MxR system to the surgical planning of a complex fourth ventricular lesion proved relevant in designing the best surgical approach and trajectory to better identify potential intraoperative challenges and rehearse the patient-specific anatomy.”

“Basing on these analyses transcatheter treatment was preferred to open surgery.”

“a fluoroscopic view with right-sided oblique angulation to 15° would provide the optimal approach to the neuroforamen with minimal risk to infiltrating the mass or nerve root”

“Modifications to 2-dimensional and "top-down" VR trajectory plans were made after "bottom-up" navigation in all cases.”

“It was used for planning the scope of the surgery and was the basis for the decision regarding the choice of the surgical technique.”

“Trocar positioning also had benefit from the preoperative VR HMD study in all cases.”

“In 33% of cases (two out of six), the preoperative decision was adjusted due to the 3D VR-based evaluation of the anatomy.”

33%

“After revision of the CT scan with holographic 3D reconstruction, endoscopic closure of the fistula with an Amplatzer device (AGA Medical, Plymouth, Minnesota, USA) was planned through a combined bronchoscopic, oesophagoscopic and fluoroscopic approach.”

“The 3D visualization of pathological conditions resulted in correct preoperative surgical planning and less invasive surgery in all five cases.”

“Therefore, the planning for removal was changed to not only use gripping forceps but also to cut the granulation tissue and remove the metallic part.”

“The surgical strategy was adjusted in 11.8% of the cases due to the 3-dimensional virtual reality-based anatomy evaluation.”

11.8%

“We then revised the approach using the 360VR model, allowing us to fly through the plan and ensure that no vital structures were compromised”

“If the patients would have been operated, adding the 3D VR tool to the preoperative workup would have resulted in changing the surgical strategy (i.e. lobectomy versus segmentectomy) in 4 cases.”

4 cases

“the multidisciplinary team was able to determine preoperatively that the renal artery would be challenging to isolate but that reconstruction was possible”

“Three out of seven participants preferred to modify their original plan after using the desktop application”

3 of 7 participants

“Patient 1 was not felt to be a candidate for HVAD implantation, because during VR placement of the pump within the chest, the pump inflow would have been located within the system AV valve annulus.”

“In 40% of the cases, the surgical strategy was adjusted due to the 3-dimensional-VR-based evaluation of anatomy.”

40%

“After using our system, the surgeons experienced an increase in their confidence regarding the surgical approach in two thirds of the cases and reported that they would have modified their original plan in 60% of the cases.”

60% of cases

“We could confirm that the inflow cannula will not impinge on the mitral valve. He was hence offered an LVAD implant.”

“Viewing the models in virtual reality allowed the team to precisely locate the defects and decide on a hybrid transcatheter and surgical approach to ensure successful repair.”

“For two cases, the plan changed after reviewing the patient's 360°VR model from one based on conventional Digital Imaging and Communications in Medicine imaging.”

“Use of the 3D VR was used during preoperative planning allowing a better definition of surgical strategy.”

“Due to better preoperative planning in VR, the operation plan was modified and thoracoscopic port placement locations were changed according to the insights provided by VR-guided planning.”

“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 surgical plan to close the 1-mm interatrial communication was significantly modified based on the pre-procedural spatial awareness of the anatomy presented in the virtual visualization.”

“The application of 3D printed and AR models is safe and feasible and can influence surgical decisions.”

“These models may alter the surgical plan, and could promote both nephron-sparing surgery and preservation of healthy parenchyma, as surgeons gain a better visualization of the size and location of a tumor in relation to normal tissue and vital structures.”