Benefit of virtual reality during visceral artery aneurysms open and endovascular surgery planning

To assess the influence of three-dimensional (3D) virtual reality (VR) analysis on surgical decision-making in visceral artery aneurysms (VAAs) surgery, aiming to optimize treatment selection and surgical planning.

A total of 10 patients with VAAs were selected. Ten surgeons were each assigned to analyze three of these aneurysm cases. Contrast-enhanced computed tomography scans were initially analyzed with standard two-dimensional multiplanar reconstructions and subsequently with 3D VR reconstruction using a VR headset running the Avatar Medical Vision software. Surgeons were required to choose between managing the aneurysm via open repair (OR) (resection-anastomosis, aneurysmorrhaphy or bypass) or endovascular procedure (EP) (embolization and/or stenting). After VAA analysis and procedure planning, surgeons completed a qualitative variable-based questionnaire using a discontinuous scale of approval levels. The time taken to analyze VAAs using VR was also recorded.

Ten patients (aged 55-76 years) with VAAs involving four splenic arteries, two renal arteries, one celiac trunk extending to the splenic artery, one patient with both splenic and renal artery aneurisms, and two duodenopancreatic arch aneurysms (one associated with celiac trunk occlusion) were analyzed. Surgeons reported enhanced VAA location, anatomy assessment, and collateral diagnosis (83%, 90%, and 76%, respectively) using VR. Improved procedure planning and anticipation of challenges was also reported (62% and 72%, respectively). The choice of procedure (OR vs EP) was modified in 15% of cases after 3D VR analysis.

This pilot study demonstrates consistent results regarding the use of VR for preoperative evaluation of patients with VAAs. The learning curve is short, and the analysis process is not time consuming. VR is a promising tool to optimize treatment selection (EP or OR).