An Immersive Collaborative Virtual Environment for Surgical Planning: Project VR-Surgical

Abstract

This chapter describes VR-Surgical, an immersive collaborative virtual reality environment designed to assist medical teams to perform surgical planning. This prototype is designed to improve surgical planning between medical teams in both remote and co-located settings. The system makes it possible to define, adjust, and annotate virtual resections of organs’ 3D surfaces and 2D image slices from MRI and CT scans. By integrating Insight Toolkit (ITK) core capabilities with VR-Surgical, it is possible to process, register, and visualize various imaging modalities during the meeting. This chapter discusses the fundamental components of a prototype system and a small pilot usability study conducted by two teams of radiologists and surgeons. It shows significant improvements in time and accuracy of the surgical planning process.

1. Introduction

The use of medical collaborative virtual environments (MCVEs) is revolutionizing surgical planning by giving medical professionals immersive, interactive, and real-time platforms to collaborate, visualize, and simulate surgical procedures. Pre-operative strategies can be improved, and surgical outcomes can be enhanced by remote MCVE over the Internet. Surgical teams’ interactions and preparation can be significantly impacted by this approach, especially when dealing with complex cases. Let us take a closer look at the components and advantages of this technology:

• Remote collaboration: In MCVE, surgeons and other medical specialists from different locations can meet in an interactive immersive virtual environment. This is particularly advantageous for complex cases where multiple specialists are needed. Despite their physical separation, they can view and discuss plans for the procedure together by utilizing 3D patient-specific models that can be manipulated in real time by team members. The system enables the annotation of 3D models, performs resection, modifies transfer functions, and processes data using the Insight Segmentation and Registration Toolkit (ITK). Participants can also access medical reports and other remote information using a virtual web browser located in the virtual meeting room. In the end of a session, VR-Surgical can document and save the designed surgical plan in detail.

• Remote access to expertise: By using this technology, one can access a wider range of experts that may not be available locally. Collaborating in real-time, discussing strategies, and making decisions together, allows surgeons, radiologists, and other healthcare professionals to create an optimal surgical procedure for each patient.

• 3D visualization and interaction: Modern MCVEs can render detailed three-dimensional images from patient imaging data, such as CT and MRI scans, which allows surgeons to manipulate and explore these images in a shared immersive virtual space. Clarifying the anatomical complexity of patients can be crucial for planning the surgical approach and predicting potential challenges. Surgeons can benefit from using these models to explore and comprehend complex anatomical structures in a way that 2D images cannot. These 3D models allow surgeons and medical teams to interact to rotate, zoom, and cut through various layers to gain comprehensive insights into the surgical site and its relationship to the surgical procedure.

• Artificial intelligence (AI) and machine learning: By analyzing patient data, AI algorithms can help predict surgical outcomes, optimize procedural plans, and identify potential risks. Using this data-driven approach, personalized surgical plans can be tailored to each patient’s needs. In some MCVEs, machine learning algorithms are used to automatically segment and analyze medical imaging data, which simplifies the workload of radiology staff before the meeting.

• Training and education: Not only can these environments be used for surgical planning, but also for educational purposes. Surgeons and medical students can have an immersive learning experience without the risks associated with actual surgery.

• Scalability and flexibility: Since MCVE operates over the Internet, it can be scaled to accommodate various users with wireless G5 connections, allowing collaboration outside the hospital setting. In addition, the system can be integrated with other digital health records for a more comprehensive approach to patient care.

• Patient involvement: The system also allows patient involvement, where patients can be guided through their anatomical models and understand the surgical plan, which can help reduce anxiety and improving patient satisfaction and outcomes.

Overall, MCVE for surgical planning over the Internet is not just about enhancing the surgical planning itself, but also improving the entire ecosystem of medical training, patient care, and international collaboration. This chapter aims to provide an overview of VR-Surgical, a prototype MCVE system that enables surgical teams to plan surgeries through immersive networked virtual collaboration.

Section 2 will briefly review the evolution of MCVE for surgical planning. Section 3 will describe the software architecture of VR-Surgical, which is composed of Unity 3D, ITK, and MiddleVR. Section 4 demonstrates the current capabilities of the VR-Surgical prototype. In Section 5, we present small pilot usability studies of the prototype. We will then conclude by describing the advantages and future of these systems, in Section 6.

2. Literature review

MCVE systems have undergone a significant change from simple virtual reality simulation applications to sophisticated, immersive platforms that are designed for surgical planning. In this review, we will examine the significant advances and technology in MCVEs for surgical planning from 1990 to 2024. This review highlights the significant contributions and technological milestones that have shaped this dynamic field.

During the early 1990s, VR was first used in medicine by the pioneering work of Jaron Lanier [1] with a primary focus on simple simulations that allowed for visualization of anatomical structures. One of the key components was the development of 3D reconstruction techniques such as the marching cube algorithm [2] to accommodate the limitations of graphic processors that could only render triangles. Initiatives like the Visible Human Project [3] began using digital anatomical models for training, but they did not have the interactivity of later systems.

During the late 1990s and early 2000s, advancements in imaging techniques like MRI and CT scanners allowed for the creation of more detailed and accurate 3D models of patients. In addition, advances in faster graphic processors by Silicon Graphics were essential to display these more precise surgical models. Using these advancements, early surgical planning tools were developed by Gibson [4] and Smith [5]. The introduction of networked environments has also contributed to enabling multiple users to interact within the same virtual space, resulting in collaborative planning and training sessions among surgical teams. The work by Shapiro et al. [6] and Harrisson et al. [7] were instrumental to demonstrate the capabilities of MCVE. In addition, the introduction of haptic feedback devices provided tactile sensations necessary to enhance the realism of surgical simulations by allowing users to feel textures and resistances akin to real-world surgical environments. Most notably the works of Salisbury et al. [8] and Lin et al. [9] were instrumental in demonstrating how haptic devices can improve the ability to perform surgical training.

The precision of surgical planning was significantly improved in 2010 thanks to further advancements in computational power and imaging technology, which resulted in high-quality 3D patient-specific models. This was demonstrated by the work of Johnston et al. [10] and Chen et al. [11]. The integration of real-time patient data into collaborative virtual environments has enabled dynamic adjustments to surgical plans based on live data from the operating room [12]. The integration had a significant impact on adapting to changes during surgery [13]. The development of devices such as the Microsoft HoloLens helps to introduce Augmented Reality (AR) technologies in the operating room to overlay critical information and 3D models onto the physical world, aiding surgeons in planning and executing procedures with enhanced spatial awareness. A review of AR in surgery can be found in [14, 15]. Real-time collaborative surgical planning became more feasible and effective using cloud computing, which facilitated efficient data sharing and collaboration across different locations. Smith et al. [16] and Wang et al. [17] describe the benefits of cloud-based solutions in surgical planning.

Today, surgical planning is now being assisted by AI and machine learning algorithms, which offer predictive analytics, automatic segmentation of medical images, and enhanced decision support. These innovations have significantly improved the accuracy and efficiency of surgical planning. Wang et al. [17] and Zhang et al. [18] provide an overview of the application of AI to surgical planning. The development of highly immersive VR Head Mounted Displays (HMDs) with video-based tracking and high-resolution displays has also significantly changed the use of VR HMDs in surgical planning environments [19]. With the help of advanced interactivity, such as gesture recognition and voice control, the usability and effectiveness of collaborative virtual environments have significantly improved. Brown et al. [20] evaluated the impact of immersive VR on surgical planning. In [21], there is a review of VR platforms for surgical training and planning. Patient-specific models based on genetic information and other personalized data can now be used in collaborative virtual environments to create highly tailored surgical plans that consider individual patient characteristics as described in [22, 23]. The increasing acceptance and regulatory approvals of VR and AR tools for surgical planning have led to their broader adoption in clinical settings, ensuring that these technologies meet safety and efficacy standards. A review of such standards is described in [24, 25]. The recent rollout of 5G technology has improved the speed and reliability of data transfer, making real-time collaboration more seamless and efficient. Effective implementation of CVEs in surgical planning requires this development. The impact of 5G on surgical planning and collaboration has been studied and can be found in [26, 27].

3. VR-Surgical software architecture

Our system is built around a pragmatic approach that brings together immersive VR capabilities from Unity 3D, medical imaging processing from Insight Segmentation and Registration Toolkit (ITK), and robust networking and data management functionalities from Middle VR. Figure 1 depicts the system’s concept diagram. The system’s design is explained in detail here.

Figure 1.

VR-Surgical concept.

3.1 System overview

Creating an intuitive, efficient, and conducive interface and user experience for surgical planning software is crucial to ensuring high-quality patient care. Here are some essential principles and considerations we used to create VR-Surgical:

• User-centered design: We conducted extensive studies during the project to comprehend the needs, workflows, and pain points of surgeons and medical staff to plan surgeries using current tools. Our design process was guided by detailed user personas to ensure that the software meets the needs to perform surgical planning more efficiently.

• Intuitive and clean interface simplicity: Our objective was to create an immersive interface that is clean and uncluttered, with a focus on essential features and avoids unnecessary complexity. To lower the learning curve for a surgical team, we employ consistent design patterns, icons, and terminology throughout the interface.

• Efficient workflow integration: The software was designed with the aim of seamlessly integrating with existing hospital systems, including electronic health records and medical imaging formats such as Digital Imaging and Communications in Medicine (DICOM).

• Accessibility and usability: Our medical collaborators and us conducted usability testing regularly at each stage of development to identify and address issues and ensure that we meet their expectations.

A VR-Surgical system prototype was created based on those design principles. VR-Surgical aims to demonstrate how multiple surgeons and medical practitioners can work together in a virtual environment to create and plan surgeries that are specific to each patient. Using Unity 3D and the Middle VR plugin, a client-side application was developed to support various VR hardware and manage immersive user interactions. The ITK library is employed for the processing of medical images. Figure 2 shows the software architecture of a VR-Surgical client.

Figure 2.

Software architecture of VR-Surgical client.

3.2 VR-Surgical is based on unity 3D

Unity 3D is a game engine and development platform that is both powerful and versatile. It is commonly used to create interactive content in video games, simulations, and visualizations. The excellent VR and AR capabilities make it an excellent choice for VR-Surgical. The core features of Unity 3D that we used in this project are:

• Multiplatform support: Unity’s comprehensive platform support makes it a great choice to develop applications for over 25 platforms, such as Windows, macOS, Linux, iOS, Android, and various VR and AR devices. Our application requires this flexibility because participants may have different types of devices, such as mobile phones and laptop computers. While some devices are VR compatible, others, such as mobile phones and desktop computers, may only be capable of displaying 2D rendering.

• Integrated development environment (IDE): Unity has a comprehensive IDE that combines all the necessary tools for VR development. Importing assets, writing scripts in C#, and assembling scenes can all be done within a user-friendly interface. VR-Surgical functionalities were made possible using C# scripting. These scripts are responsible for handling DICOM readers, processing medical images with ITK, creating avatar animations of the participants, accessing databases, and other tasks.

• Graphics rendering: Unity’s powerful graphics engine allows it to render 2D and 3D graphics. For medical image rendering, we used one of the volume rendering assets from the Unity store. Its capabilities include: easy import of volumetric data mainly in DICOM format; interactive visualization functionalities such as rotation, zoom, and slicing; a set of shaders for different rendering techniques such as direct volume rendering and iso-surface rendering; functions to define transfer functions to enhance the visibility of different materials or structures based on their densities; and finally GPU-based rendering and multi-threading support to handle large datasets efficiently. Another key advantage of Unity 3D is its extensive support for VR and AR development, providing a range of tools and APIs to create immersive experiences for surgical planning and eventually image- guided surgeries.

• Physics engine: The robust physics engine in Unity 3D allows for the realistic simulation of physical interactions in surgical simulation. In this prototype, the physics engine is mainly used for collision detection and rigid transformation of medical image objects. Using this physics engine, we are currently developing extensions to VR-Surgical that can perform basic surgical simulations.

3.3 VR-Surgical and middle VR

Middle VR is a powerful middleware for developing and deploying virtual reality applications, particularly well-suited for collaborative applications like ours where high levels of interactivity and multiple user engagement are required. By providing robust support for various VR hardware and seamless integration with Unity 3D, Middle VR enabled us to build sophisticated VR applications like VR-Surgical that are both accessible and scalable.

The core elements of Middle VR used in VR-Surgical are:

• VR device integration: Middle VR can support a wide range of VR devices, such as HMDs, motion trackers, 3D mice, and haptic devices. By combining Meta Quest Pro with Middle VR, we were able to significantly improve the quality and efficiency of virtual reality experiences in our application. Meta Quest Pro headsets can operate independently and process everything on the device. Due to the absence of the need for an expensive computer or complex setup, they are more accessible and easier to use than PC-tethered VR systems. The headset and controllers offer 6 degrees of freedom for users to move around and interact with the virtual environment realistically. VR-Surgical most recent release employs the Meta Quest Pro’s capabilities to conduct hands-free tracking, enabling users to interact with VR content without the use of hand controllers. The Meta Quest Pro is enhanced by high-resolution OLED screens that offer clear and vibrant visuals, contributing to a more immersive VR experience. The Meta Quest Pro’s built-in speakers deliver spatial audio, allowing users to hear the voices of the participants without the need for external headphones.

• Multi-user support: Middle VR’s uniqueness lies in its support for multi-user environments. This feature allows multiple users to interact with various devices in real-time within the same virtual space. If a participant connects to the system with a mobile phone, Middle VR can adapt the capability of VR-Surgical to deal with its limitations, i.e., 2D display instead of 3D and mouse navigation instead of hand tracking, etc.

3.4 VR-Surgical and ITK

The primary purpose of ITK, which was created through collaboration between different institutions, is to process and analyze visual data in medical imaging applications. Written in C++ its integration with Unity 3D, necessitates the development of custom plugins that can directly utilize ITK’s processing capabilities. This allows for on-the-fly image processing in the VR-Surgical environment. Once data is imported in Unity 3D one can use shaders, materials, and Unity’s volume rendering capabilities to visualize the data. The primary use of ITK in VR-Surgical is to register various imaging modalities and filter volumetric data.

3.5 VR-Surgical data server

The VR-Surgical data server is a key element of the system. It manages data and processes user inputs, thus ensuring the virtual environment state is maintained across multiple sessions. It consists of:

• Data management service: Handles storage, retrieval, and management of medical imaging data. The current system supports DICOM data CT, MRI, PET, Ultrasound, Fluoroscopy, and Radiography; Medical reports as PDF; Patient outcome information as PDF; and Current patient’s physiological condition.

• Real-time collaboration manager: Manages interactions and updates across client applications while coordinating activities between multiple users. Separation between client interfaces and data processing and management tasks handled by the server is made possible using a client-server architecture. Our system’s architecture is based on a microservices architecture, where each server component (data handling, user management, and real-time collaboration) can operate independently. The result is enhanced scalability and maintenance ease. Our implementation is based on the Google Fire Store database, which is a flexible and scalable database for mobile, web, and server development. As the successor to Firebase Realtime Database, it offers enhanced data structuring and more robust querying.

• Interaction flow: The interaction between surgeons takes place on the Unity-based client application platform. The server receives inputs, such as rotations, annotations, patient’s reports and patient-specific 3D models. By processing these inputs, the server updates the virtual environment’s state and sends it back to all connected clients. Synchronization is ensured by the Middle VR by keeping a consistent state across all user interactions. It is also responsible for updating the position and gestures of the participants’ avatars using the HMD position/orientation to locate the avatar in the meeting room as well as hand tracking to animate the avatar interaction such pointing and signaling.

3.6 VR-Surgical security and ethical considerations

Creating a data server for healthcare requires careful consideration of various technical, regulatory, and ethical aspects. A healthcare data server is typically responsible for handling sensitive information, such as patient records, medical imaging data, and operational data from different healthcare departments. VR-Surgical created a strong data server that adhered to the rules listed below.

• Scalability: Increases in data volume can be handled by the server without affecting performance. Middle VR capabilities enable the expansion of scalable cloud solutions or modular hardware architectures as needed.

• Reliability and availability: High availability is necessary in healthcare, as system downtime can affect patient care. Even when there are partial system failures, the server is still operational thanks to redundant hardware, failover clustering, and load balancing techniques. We employ a straightforward method in our implementation where we download all datasets (medical images, reports, etc.) locally from a secure Google server before the meeting. The annotated medical images and surgical plans are saved on the same data server after the meeting, which can be used during the surgery or to review the design.

• Security: Security is of utmost importance due to the sensitive nature of medical data. Strong encryption for data at rest and in transit was implemented in VR-Surgical, along with robust authentication and authorization mechanisms. Our data server complies with the standards set by the Health Insurance Portability and Accountability Act (HIPAA).

• Ethics: Ethical considerations are essential when developing and implementing surgical planning software to ensure patient safety, privacy, and overall well-being. These are the key ethical considerations that were utilized in the development of VR-Surgical:

  • Accuracy and reliability: To avoid errors that could harm patients during the procedure, it is crucial to make sure the software is accurate and reliable. As VR-Surgical progresses, it is always necessary to regularly assess and mitigate risks associated with its use. It is also important that surgeons and medical staff are adequately trained to use the software effectively and comprehend its limitations. For the first release of VR-Surgical we developed a basic training module for a stent procedure to treat coronary artery disease that was greatly appreciated by the teams and was used during the usability study.

  • Ethical use of AI and machine learning: VR-Surgical future version must make sure that AI-driven decisions and recommendations are understandable for both surgeons and patients. VR-Surgical should always be supervised by humans when validating and interpreting AI-generated plans and suggestions. It is also important to be open about reporting any issues, errors, or adverse events related to the software.

4. VR-Surgical prototype

The prototype system’s functionality will be demonstrated in this section. Before a meeting takes place, the organizer must create a script file that contains the necessary information for the meeting. It includes:

• The number of participants.

• The names and locations of every participant.

• The IP addresses for every participant.

• Usernames and passwords for each participant.

• Medical Imaging file names to be used in DICOM format.

• List of patient reports in PDF format.

Let us look at the functionality of the prototype system by illustrating each stage of a meeting.

4.1 Step 1: connecting with a participant

The first step an organizer must take is to establish a connection with another participant. As illustrated in Figure 3a, the organizer must select the networking item from the virtual drop-down menu and then start connecting with the participant. Then he must start a host server (Figure 3b). Once connected, the participants will appear on both sides of the meeting as animated avatars. Each avatar’s location and hand gestures are defined by the HMD locator and the hand and finger locations (Figure 3c) by the Meta Oculus Pro. Once connected, participants can view the meeting information collaboratively or individually (Figure 3d). If collaborative visualization is selected a designated participant will control the visualization.

Figure 3.

Setting up the network connection and connecting with the participants.

4.2 Visualizing, manipulating, and annotating patient’s medical imaging data

One of the key functionalities of VR-Surgical is its ability to share medical imaging data between participants, which can be visualized at various viewing angles using the wand or hand control (Figure 4a). Depending on which participant has control, they can interactively apply a clipping plane to select a slice of volume data (Figure 4b).

Figure 4.

Manipulating, slicing, and annotating medical imaging data.

During their conversation, both participants use pointers to highlight regions of interest in the volume data. Each participant’s annotation has a different color that can be selected interactively (Figure 4c and d). These regions of interest will be saved by the system at the end of the session for future reference.

4.3 Virtual webpage browser

VR-Surgical can display an interactive board in a virtual meeting that functions like a web browser. Figure 5a shows how each participant can access information on the WWW or medical databases using this functionality. Because the virtual web browser is the same as a normal web browser, participants can connect to computational services such as Google Collab to process images using Python notebook. The results of the processing are then saved in the VR-Surgical server and can be viewed collaboratively in the virtual environment. Furthermore, Unity 3D natively implements basic ITK functionality for processing locally. Once processed, the information can be saved on the VR-Surgical server and displayed collaboratively. This enables participants to process information separately and then discuss the results in a collaborative manner. In addition, each selected web page can be annotated using the virtual pointer to highlight important information (Figure 5b).

Figure 5.

Virtual web browser located in the virtual meeting room.

4.4 Meeting recording

VR-Surgical can record meetings and save them on the server. It is possible to save all information (including 3D models, participant movements, voices, virtual browser data, etc.). To play back this recording and share information with other participants during a meeting, a participant can use a slider that resembles the one used by video players.

5. Prototype usability study

A small usability study for VR-Surgical was conducted in our laboratory. Due to the challenge of obtaining access at the same time to a radiologist and a surgeon, our study was limited to three teams. We made the decision to present five different cases to each team, generating 15 experimental results. The first case is for training purposes and the four others were actual experiments. The purpose of the task was to plan for a stent procedure. A stent procedure is used to open narrowed or blocked arteries and enhance blood flow. This is typically necessary in conditions such as coronary artery disease (CAD), peripheral artery disease (PAD), and in the arteries of the kidney (renal stenting), among others. The following steps are necessary for pre-operative surgical planning for a stent procedure using a contract-enabled CT scan:

1. CT scan review: The contrast CT images are reviewed by radiologists and surgeons to assess the patient’s anatomy and the extent of the condition that necessitates stent placement.

2. Image processing and segmentation: A detailed 3D model of the relevant blood vessels and surrounding structures is created by using special software to process and segment contract-enhanced CT images. It is also used to highlight the location of blocked arteries.

3. Measurements and analysis: After finding blocked arteries, key measurements are carried out, which involve measuring vessel diameters, lengths, and any areas of stenosis or aneurysm. This information is critical for selecting the appropriate size and type of stent.

4. Stent selection: Based on the measurements and anatomical considerations, the surgical team selects the appropriate stent type and size.

5. Procedure planning: During this step the surgical team discuss where to insert the catheter and to anticipate potential challenges.

The total time for these steps can vary widely depending on the complexity of the case, the availability and experience of the surgical team, and the efficiency of the imaging and planning software. The surgical planning team normally uses FDA-approved TerraRecon, the leading advanced visualization and AI platform on the market. According to our medical team members, the planning process can take on average of 1.0 hour/case using TerraRecon. This includes loading the patient’s contrast CT images, processing the information to locate the clots, performing measurements to determine the stent size and type, and finally planning and documenting the procedure.

5.1 The experiment

Each team starts by performing a first surgical planning talk (with three CT images) to become familiar with the interface. Once familiar with the interface a planning session for four medical cases is then presented to them to solve. During the session, the team performance is evaluated using total planning completion time per case (hours) relative to the average time to perform the same tasks using TerraRecon. The accuracy of locating the targets (clot localizations) in mm is also measured. After the five cases, a Likert questionnaire exploring how each team member feels about the performance of VR-Surgical compares to TerraRecon. Using a scale between 0 and 5, the questionnaire assessed how the collaboration between the radiologist and surgeon was perceived for each experiment. The interface’s overall user satisfaction was also assessed compared to TerraRecon using a scale ranging from 0 to 5 after each experiment.

The results were:

• Efficiency: VR-Surgical allowed each team to finish surgical planning experiments within an average of 2.3 hours, equivalent to an average of 34.5 minutes per case, with an 8-minute variance. Most of the time (16 minutes on average) was dedicated to investigating CT scans to pinpoint the obstructed arteries. Compared to TerraRecon, which takes an average of 60 minutes per case for surgery planning, this is a significant time reduction. The time reduction is primarily attributed to VR-Surgical’s capability to collaboratively visualize and annotate contract CT data. VR-Surgical real-time collaboration was also appreciated by them as it likely reduced the need for multiple planning sessions and simplified the decision-making process by improving the ability to choose the best stents for each clot and to plan better the catheter insertion route.

• Accuracy: The accuracy of localizing the clot was on average 2.5 mm with a standard deviation of 0.25 mm, which corresponded to the actual resolution of the CT volume images. Our teams determined that this was sufficient to accurately select the stent size and type for each clot. They mentioned that using the enhancement of 3D visualization and interactive tools in VR-Surgical it possible to obtain better stent selections and a better understanding of intricate anatomical structures to reach the clots. TerraRecon has similar capabilities for planning, but due to the limitations of 2D display, anatomical information is more difficult to interpret, which necessitates a higher level of expertise and may result in errors for novice users.

• Collaboration: According to our medical testing teams, VR-Surgical improved collaboration and communication. The participants’ evaluation of VR-Surgical compared to TerraRecon was on average 4.7 out of 5 better with a standard deviation of 1.2. VR-Surgical was perceived as a more effective communication tool for interdisciplinary collaboration than TerraRecon, allowing for immediate feedback and adjustments during the planning phase.

• User satisfaction: When comparing the VR-Surgical system to TerraRecon, users expressed average satisfaction scores of 4.0 out of 5 with a standard deviation of 1.2. The user-friendly interface, 3D medical image interaction, and overall planning improvement were all appreciated by participants and was considered a significant improvement over TerraRecon session especially when virtual meetings are necessary. They mentioned that other pointing techniques should be utilized because the current version is difficult to control. They also mentioned that the virtual web browser can be useful to bridge virtual meetings with their day-to-day practice, for example by showing patient records, emails, and agendas.

Based on this limited pilot study, it is apparent that we are on the right track. Our plan is to conduct a long-term study to observe how VR-Surgical usage affects surgical outcomes and gather more comprehensive data on its effectiveness.

6. Conclusion

VR-Surgical demonstrates how surgeons and medical teams can collaborate remotely, no matter their geographical location, to carry out surgical planning. The small usability study shows that VR-Surgical can indeed improve decision-making before surgeries, but more testing and improvements are necessary before deployment in clinical environments. The key advantage of the current version of VR-Surgical is its ability to deliver immediate feedback and discussion through real-time interaction that relies on shared visualizations of patient data and surgical plans. VR-Surgical advantage lies in its integration of not only being able to visualize immersivity imaging data, but also to bring to the planning room physiological data, genetic information, and real-time intraoperative data by using the virtual web browser. Adopting this holistic approach allows the team to have a better understanding of the patient’s condition and optimize surgical strategies.

Future development of VR-Surgical will incorporate AI capabilities to enhance decision-making by analyzing complex datasets and suggesting optimal surgical plans based on the framework developed during this project. This can include predicting outcomes based on historical data and recommending personalized approaches tailored to individual patient characteristics. The use of advanced technologies will lead MCVEs to revolutionize surgical planning, improve outcomes, reduce risks, and enhance the overall quality of patient care.