Developing a Virtual Reality Simulation System for Preoperative Planning of Robotic-assisted Thoracic Surgery
Authors: Ujiie Hideki , Chiba Ryohei , Yamaguchi Aogu , Nomura Shunsuke , Shiiya Haruhiko , Fujiwara-Kuroda Aki , Kaga Kichizo , Eitel Chad , Clapp Tod R. , Kato Tatsuya 
Published: January 2024

Background
Robotic-assisted thoracic surgery (RATS) has become the standard procedure for treating lung malignancy, offering numerous advantages over traditional methods. However, the minimally invasive nature of RATS presents unique challenges, notably a limited field of view and reduced tactile feedback for the surgeon. These limitations can significantly impact the surgeon&#039;s ability to navigate complex anatomical structures during surgery. To address these challenges, we recognized the need for enhanced preoperative familiarization with each patient’s specific anatomy. In response, we developed an innovative virtual reality (VR) surgical navigation system, utilizing head-mounted displays (HMDs), designed to provide surgeons with a more comprehensive and interactive understanding of the patient&#039;s anatomy before the actual surgery. This VR system aims to extend the surgeon&#039;s capabilities in both preoperative sumilation and intraoperative navigation, potentially mitigating the inherent limitations of RATS.
Methods
Three-dimensional (3D) volumized data, meticulously extracted from preoperative computed tomography (CT) scans, were seamlessly integrated into the Perspectus VR Education software. These data were then displayed on an HMD, facilitating an interactive 3D reconstruction of pulmonary structures. This reconstruction allowed for each structure to be visualized individually, enabling detailed preoperative resection simulations tailored to each patient&#039;s unique anatomy. During RATS, these specific 3D reconstructed images were made accessible within the surgeon&#039;s console through the TilePro™ multi-display input, providing real-time, intraoperative guidance.
Results
During the preoperative simulations, the 3D anatomic structure of the pulmonary vessels, as well as the spatial relationship between the lesion and adjacent tissues, were successfully visualized. This enhanced visualization enabled surgeons to thoroughly evaluate a patient&#039;s anatomy, significantly improving the safety and accuracy of the subsequent procedure. The integration of VR software with the HMD provided surgeons with a true 3D interaction with real patient data. This setup not only offered a unique perspective through the surgical console but also allowed for easy manipulation of the data on a mobile laptop, thereby enhancing the overall surgical planning process.
Conclusions
VR simulation using HMDs offers a viewing experience akin to that of a robotic 3D viewer, potentially providing an innovative avenue for surgeons to develop specific robotic surgical skills without the need for practicing on live patients. This technology, when integrated with routine imaging modalities, can significantly enhance preoperative planning. Such integration not only contributes to the safety but also improves the accuracy of anatomical resections. Our findings suggest that VR simulation with HMDs is particularly effective in assisting surgeons to accurately identify lesion locations in RATS, thereby optimizing surgical outcomes.