Patient-individualized resection planning in liver surgery using 3D print and virtual reality (i-LiVR)—a study protocol for a prospective randomized controlled trial

Abstract

Background A multitude of different diseases—benign and malign—can require surgery of the liver. The liver is an especially challenging organ for resection planning due to its unique and interindividually variable anatomy. This demands a high amount of mental imagination from the surgeon in order to plan accordingly - a skill, which takes years of training to acquire and which is difficult to teach. Since the volume of the functional remnant liver is of great importance, parenchyma sparing resections are favoured. 3D reconstructions of computed tomography imaging enable a more precise understanding of anatomy and facilitate resection planning. The modality of presentation of these 3D models ranges from 2D monitors to 3D prints and virtual reality applications. Methods The presented trial compares three different modes of demonstration of a 3D reconstruction of CT scans of the liver, which are 3D print, a demonstration on a regular computer screen or using a head-mounted virtual reality headset, with the current gold standard of viewing the CT scan on a computer screen. The group size was calculated with n=25 each. Patients with major liver resections in a laparoscopic or open fashion are eligible for inclusion. Main endpoint is the comparison of the quotient between planned resection volume and actual resection volume between these groups. Secondary endpoints include usability for the surgical team as well as patient specifics and perioperative outcome measures and teaching issues. Discussion The described study will give insight in systematic planning of liver resections and the comparison of different demonstration modalities of 3D reconstruction of preoperative CT scans and the preference of technology. Especially teaching of these demanding operations is underrepresented in prior investigations. Trial registration Prospective trials registration at the German Clinical Trials register with the registration number DRKS00027865. Registration Date: January 24, 2022.

Three-Dimensional Printed Liver Models for Surgical Planning and Intraoperative Guidance of Liver Cancer Resection: A Systematic Review

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The future of surgical simulation

“…Nonetheless, innovation always require a scientific evaluation of the new technical possibilities according to IDEAL criteria (5). Therefore, we started a prospective randomized clinical trial to evaluate the influence of 3D reconstruction and its visualization technologies on resection planning in liver surgery that includes 3D PDF, 3D PR and 3D VR and a control group (6). Since our own experiences confirm the authors' opinion that 3D reconstruction is not beneficial in simple minor resections, inclusion criteria for the i-LiVR-Trial are major liver resections or minor resections with high complexity.…”