Individualised Liverresection Planning using 3D printing and Virtual Reality (i-LiVR)

在德国，每年大约有3万名恶性肝脏肿瘤或转移患者接受肝脏手术。在治疗方法的背景下，技术和功能可切除性描述了在保留足够大的残余肝体积的同时完全切除肿瘤的可能性。肝脏是一个高度灌注的实质器官，这对外科医生来说是一个重大的技术挑战。血管解剖结构的巨大个体差异加强了这一点。因此，进行肝脏切除术需要精确的术前计划。目前使用切片成像（CT或MRI）作为二维数据集来完成。三维变换通常是由外科医生的想象力来完成的。基于计算机的程序提供了三维重建的可能性。这些3D重建通常以交互式PDF文件的形式显示在传统屏幕上。3D打印现在可以借助肝脏的3D模型进行规划。器官模型也可以使用虚拟现实技术来表示。一种专门开发的应用程序使单个3D肝脏重建的虚拟表示成为可能。还可以与多个用户同时进行多功能交互。到目前为止，不同的3D呈现方式对手术计划以及术后过程的影响尚未被调查。提出的项目代表了一项单中心临床研究，其中上述形式的表现在肝脏手术的背景下随机使用。肝脏手术前48小时向外科团队展示解剖图。患者随机分为4组：对照组；3 d PDF格式;3 d打印;3D虚拟现实。所有组术前均可获得断层图像。主要问题是计划切除量的变化以及手术团队的偏好。并分析了术中、术后资料及并发症。该项目的创新之处在于在肝脏手术前对几种三维表现形式进行首次临床评估，以规划手术。由于在肝脏外科和手术模拟的科学和临床重点方面的专业知识以及与计算机科学家的良好合作，这代表了该项目组的独特之处。个体化肿瘤医学领域，以及3D打印或虚拟现实等现代技术的发展和应用，在外科领域具有很高的创新潜力。

Every year, around 30,000 patients with malignant liver tumors or metastases are operated on in the liver in Germany. The technical as well as functional resectability in the context of curative therapy approaches describes the possibility of complete tumor removal while preserving a sufficiently large residual liver volume. The liver is a highly perfused parenchymal organ that can pose major technical challenges for surgeons. This is reinforced by the enormous individual variability of the vascular anatomy. Performing liver resections therefore requires precise preoperative planning of the procedure. This is currently done using slice imaging (CT or MRI) presented as a two-dimensional datasets. The three-dimensional transformation is usually carried out by the imagination of the surgeon. Computer-based procedures offer the possibility of 3D reconstruction. These 3D reconstructions are usually displayed as an interactive PDF file on a conventional screen. 3D printing now enables planning with the help of a 3D model of the liver. Organ models can also be represented using the techniques of virtual reality. A specially developed application enables the virtual representation of an individual 3D liver reconstruction. A versatile and simultaneous interaction is also possible with several users. The effects of the different 3D presentation modalities for the surgical team on the surgical planning as well as the postoperative course have not been investigated so far. The proposed project represents a monocentric clinical study in which the above-mentioned forms of presentation are used randomly in the context of liver surgery. The anatomy is demonstrated to the surgical team within 48 hours prior to liver surgery. Patients are randomized into one of 4 groups: control group; 3D PDF; 3D printing; 3D virtual reality. The preoperatively available sectional images are available in all groups. The main question is the changes in the planned resection volume as well as the preference of the surgical team. Intra- and postoperative data as well as complications are also analyzed. The innovation of the project lies in the first clinical evaluation of several three-dimensional forms of presentation for planning the operation before liver surgery. Due to the great expertise in the scientific and clinical focus on liver surgery and surgical simulation and the excellent cooperation with computer scientists, this represents a unique feature of the project group. The areas of individualized oncological medicine on the one hand and the development and use of modern technologies such as 3D printing or virtual reality on the other has a high innovation potential in surgery.