Virtual reality-assisted preoperative planning for pediatric thoracoscopic segmentectomy: a retrospective study

Congenital cystic lung malformations (CCLM) increasingly require parenchyma-sparing resections. While thoracoscopic segmentectomy offers tissue preservation benefits, its complexity demands advanced preoperative visualization. This study evaluates head-mounted display virtual reality (HMD-VR) for surgical planning in pediatric segmentectomies.

Nineteen children (4 to 148 months) underwent VR-assisted thoracoscopic segmentectomy. Patient-specific three-dimensional (3D) models were generated using Medicalholodeck^® software, integrating contrast-enhanced CT DICOM data. Surgeons performed immersive rehearsals via HMD, evaluating anatomical relationships and simulating dissection planes. Primary outcomes included technical feasibility, perioperative metrics (operative time, blood loss, complications), and anatomical accuracy validation by independent surgeons.

All procedures (100%) were completed thoracoscopically without conversion. Mean operative time was 116.3 ± 45.5 min with blood loss of 29.5 ± 20.6 ml. Pathologies comprised congenital pulmonary airway malformation (78.9%, CPAM) and others (21.1%, bronchial atresia, pulmonary sequestration, and lobar emphysema). 26.3% of cases required combined segmentectomy due to lesions spanning ≥ 2 segments. For these patients, hospital stay, intraoperative blood loss, operative time, and duration of chest tube drainage were significantly higher than for single segmentectomies (P < 0.01), although there was no significant difference in postoperative complications. Postoperative follow-up at 1, 3, and 6 months demonstrated satisfactory recovery in all patients, with no respiratory symptoms, recurrence, or mortality.

HMD-VR enables precise spatial mapping of complex pediatric pulmonary anatomy, facilitating safe thoracoscopic segmentectomies even for multi-segmental lesions. Its immersive planning optimizes surgical trajectories and mitigates intraoperative risks, demonstrating transformative potential for parenchymal preservation in CCLM management.