Available online 12 January 2024, 151387

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Virtual reality modeling (VRM) is a 3-dimensional (3D) simulation. It is a powerful tool and has multiple uses and applications in pediatric surgery. Patient-specific 2-dimensional imaging can be used to generate a virtual reality model, which can improve anatomical perception and understanding, and can aid in preoperative planning for complex operations. VRM can also be used for realistic training and simulation. It has also proven effective in distraction for pediatric patients experiencing pain and/or anxiety. We detail the technical requirements and process required for VRM generation, the applications, and future directions.

Section snippetsBACKGROUND

Virtual Reality (VR) creates a 3-dimensional (3D) computer-generated environment in which orientation and interaction with the 3D environment are possible. Head-mounted displays (HMD) project the environment in front of the user's eyes creating a wide field of view and a feeling of full immersion. Motion tracking systems allow interaction with this generated environment. When this technology is combined with patient specific VRMs (Virtual Reality Modeling), a new dimension in pre-surgical

CREATION OF A VRM

Until recently, complex imaging of patients involved ultrasound, multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI), or a combination of these tools. Each modality has seen significant technical improvements, yet all are limited by representing 3D anatomy in a 2D format. Review of these images therefore requires experts to create their own visuospatial 3D mental models from the data. Human ability to do this is quite variable1. Surgical and radiology specialties may

PREOPERATIVE PLANNING

The utilization of VR for preoperative planning is a recent development. The published series date from 2017and primarily involve adult patients. Neurosurgical, urology and cardiac surgery reports predominate, although this nascent technology has been used in general surgery, oncologic surgery, orthopedic surgery, and plastic surgery including craniofacial cases.4,5

At the Children's Hospital of Illinois, we have created over 400 clinical VRMs for preoperative planning (Table 1). The experience

PATIENT EDUCATION

If surgeons vary in their ability to visualize complex anatomy in 3D, consider how difficult this may be for patients and parents. Creation of 3D models using VR can significantly enhance communication for shared decision making11. We are currently collecting survey data at our two separate centers regarding patient/parent experience when VRM is used as part of the preoperative education and informed consent process (Figure 4). Feedback and comments to date are very encouraging.

REDUCTION OF PAIN/ANXIETY

VR technology has been used as a distraction tool to reduce pain and anxiety perioperatively, in both the preoperative and postoperative settings. Some studies suggest that there may be novel neurophysiologic benefits in addition to just distraction12 and it has been suggested that VR may even provide some benefits in the management of chronic pain, although primarily in small case reports13. Preoperative VR experiences statistically reduced anxiety and distress in a prospective randomized trial

TRAINING/SIMULATION

VR can be useful for training and simulation of clinicians, allowing experience to be gained and fostered outside of direct patient care. This can be particularly important in high-stakes arenas like surgery or in emergency, critical or trauma care. Resident duty-hour restrictions have also limited exposure and experience to some degree. More traditional simulations in the past including role-playing often felt artificial, limiting effectiveness. VR simulation can often be substantially more

FUTURE DIRECTIONS

Integrating digital assets into live clinical scenarios in the form of augmented reality (AR) holds promise, but automated segmentation and real-time co-registration solutions still need work. This is under investigation in many areas including pediatric craniofacial surgery28. As this technology continues to improve, full immersion will allow for increasingly realistic simulation. Clinical applications should be diverse. We have used VRM to locate exceedingly small 1-2 mm osteosarcoma

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© 2024 Published by Elsevier Inc.