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

在德国，每年约有30，000名患有恶性肝肿瘤或转移的患者接受肝脏手术。在治愈性治疗方法的背景下，技术和功能性可切除性描述了完全切除肿瘤的可能性，同时保留足够大的剩余肝脏体积。肝脏是一个高灌注的实质器官，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，进行肝切除术需要精确的术前计划。目前，这是使用作为二维数据集呈现的切片成像（CT或MRI）来完成的。三维变换通常是由外科医生的想象力。基于计算机的程序提供了3D重建的可能性。这些3D重建通常在传统屏幕上显示为交互式PDF文件。3D打印现在可以在肝脏3D模型的帮助下进行规划。器官模型也可以使用虚拟现实技术来表示。专门开发的应用程序可以虚拟表示单个3D肝脏重建。也可以与多个用户进行通用和同时的交互。到目前为止，尚未研究手术团队的不同3D演示模式对手术计划和术后病程的影响。拟议的项目代表了一项单中心临床研究，其中在肝脏手术的背景下随机使用上述形式。在肝脏手术前48小时内向手术团队展示解剖结构。患者被随机分为4组：对照组; 3D PDF; 3D打印; 3D虚拟现实。所有组的术前可用断层图像均可用。主要问题是计划切除量的变化以及手术团队的偏好。术中和术后数据以及并发症也进行了分析。该项目的创新之处在于首次对肝脏手术前规划手术的几种三维表现形式进行临床评价。由于在肝脏手术和手术模拟方面的科学和临床专业知识以及与计算机科学家的出色合作，这代表了项目组的独特之处。一方面是个体化肿瘤医学领域，另一方面是3D打印或虚拟现实等现代技术的开发和使用，在外科手术中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.