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The Next Frontier In Congenital Heart Surgical Planning: Surgeon-Designed Virtual Reality Surgical Simulation Suite
Ryan A. Moore, MD, MSc1, Nicholas Szugye, MD1, William Burke1, Dennis Wells, MD2, David Lehenbauer, MD2, David L. S. Morales, MD1.
1Cincinnati Children's Hospital Medical Center, The Heart Institute, Digital Healthcare Innovation, Cincinnati, OH, USA, 2Cincinnati Children's Hospital Medical Center, The Heart Institute, Cardiothoracic Surgery, Cincinnati, OH, USA.

Objective(s): Surgical planning is imperative in complex congenital heart disease (CHD) where detailing optimal approaches can improve postoperative outcomes. Virtual surgical planning is the transformation of imaging data into 3D simulations able to be manipulated by the surgeonís hands. Currently, a surgeon-designed VR surgical simulation suite (VR3S) is not readily available for prospective planning.
Methods: Over 2 years, we designed/developed a VR3S based on intensive surgeon-user feedback. Preoperative CT/MR 3D data were loaded into the VR3S for patients undergoing surgical planning. A single surgeon-user directly manipulated the 3D models to overlay patches, valves, and/or devices. After surgical approach was defined, virtual blueprints of the proposed surgery were created. The surgeon evaluated the virtual blueprints video before and after the procedure.
Results: The surgeon-user planned five complex biventricular repairs using the VR3S platform: three complex heterotaxy patients, 1 truncus canal, and 1 adolescent failing Fontan conversion to 2-ventricle circulation. Three of five patients had postoperative cross-sectional imaging with 3D modeling to demonstrate the accuracy of virtual planning. The surgeon determined the VR3S and virtual planning process to be "highly accurate" and "critical to the success" of the proposed operation. In several instances, the virtual planning process identified key anatomic relationships that altered the operative plan.
Conclusions: Virtual surgical planning has advanced rapidly utilizing VR game-engine platforms. A surgeon-designed VR3S could soon be available for open-source testing/sharing.


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