VIRTUAL-REALITY APPLIED TO HEPATIC SURGERY SIMULATION - THE NEXT REVOLUTION

Objective This article describes a preliminary work on virtual reality applied to liver surgery and discusses the repercussions of assisted surgical strategy and surgical simulation on tomorrow's surgery. Summa ry Background Data Liver surgery is considered difficult because of th e complexity and variability of the organ. Common generic tools for pr esurgical medical image visualization do not fulfill the requirements for the liver, restricting comprehension of a patient's specific liver anatomy. Methods Using data from the National Library of Medicine, a realistic three-dimensional image was created, including the envelope and the four internal arborescences. A computer interface was develope d to manipulate the organ and to define surgical resection planes acco rding to internal anatomy. The first step of surgical simulation was i mplemented, providing the organ with real-time deformation computation . Results The three-dimensional anatomy of the liver could be clearly visualized. The virtual organ could be manipulated and a resection def ined depending on the anatomic relations between the arborescences, th e tumor, and the external envelope. The resulting parts could also be visualized and manipulated. The simulation allowed the deformation of a liver model in real time by means of a realistic laparoscopic tool. Conclusions Three-dimensional visualization of the organ in relation t o the pathology is of great help to appreciate the complex anatomy of the liver. Using virtual reality concepts (navigation, interaction, an d immersion), surgical planning, training, and teaching for this compl ex surgical procedure may be possible. The ability to practice a given gesture repeatedly will revolutionize surgical training, and the comb ination of surgical planning and simulation will improve the efficienc y of intervention, leading to optimal care delivery.