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

在德国，每年大约有3万名患有肝脏恶性肿瘤或转移瘤的患者接受肝脏手术。根治性治疗方法中的技术和功能可切除性描述了在保留足够大的残留肝脏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，可能会给外科医生带来重大的技术挑战。血管解剖的巨大个体变异性加强了这一点。因此，进行肝脏切除需要对手术进行精确的术前计划。这目前是使用切片成像(CT或MRI)以二维数据集的形式来完成的。三维改造通常是由外科医生的想象力进行的。基于计算机的程序提供了三维重建的可能性。这些3D重建通常在常规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。一种专门开发的应用程序可以虚拟表示个人的3D肝脏重建。还可以与多个用户进行多种用途的同时交互。手术团队不同的3D展示方式对手术计划和术后过程的影响迄今尚未被调查。拟议的项目代表了一项单中心临床研究，在该研究中，上述介绍形式在肝脏手术中被随机使用。解剖在肝脏手术前48小时内向外科团队演示。患者被随机分为4组：对照组；3D PDF；3D打印；3D虚拟现实。所有组均可获得术前可用的断层图像。主要的问题是计划的切除体积的变化以及手术团队的偏好。并对术中、术后数据及并发症进行分析。该项目的创新之处在于首次对肝脏手术前计划手术的几种三维表现形式进行了临床评估。由于在肝脏手术和手术模拟的科学和临床方面拥有丰富的专业知识，并与计算机科学家进行了出色的合作，这代表了项目组的一个独特特点。一方面是个性化肿瘤医学领域，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.