Proof of Concept: Extended Reality-Assisted Resternotomy Planning for Complex Cardiac Surgery

Median sternotomy can cause postoperative adhesions, raising bleeding and organ damage risks during resternotomies. Computed tomography angiography (CTA) and extended reality (XR) are increasingly used to enhance surgical planning and minimize these risks. This study aims to assess the benefits of integrating XR technology into resternotomy planning.

This multi-center study, conducted at the Sheba and Wolfson Medical Centers in Israel, evaluated the utility of three-dimensional imaging in surgical resternotomy planning in 24 cases. Pediatric and adult patients selected for resternotomy underwent routine CTA, and those with adequate image quality were used to generate virtual three-dimensional segmentation. The images were evaluated preoperatively.

The findings indicated no significant benefit of XR over CTA in terms of resternotomy anatomical data. However, the accuracy of the XR models varied with medical experience: senior physicians rated the XR as less accurate for adult patients than did residents, but the ratings were high in both groups for pediatric cases. The XR models improved the surgeons' understanding of chest anatomy in pediatrics more than in adult patients, whereas for surgical decision-making, XR was seen as more beneficial in pediatric cases, particularly by senior surgeons. Overall, senior physicians reported that XR influenced their surgical decisions more, suggesting that the utility of XR varies with physician experience and patient age.

XR technologies have shown considerable potential in enhancing visualization and contributing to determining surgical strategies. However, the extent of their influence in terms of reducing operative durations and minimizing intraoperative complications requires further investigation.