Magnetic resonance cholangiopancreatography enhanced by virtual reality as a novel tool to improve the understanding of biliary anatomy and the teaching of surgical trainees

Sebastian M Staubli; Peter Maloca; Christoph Kuemmerli; Julia Kunz; Amanda S Dirnberger; Andreas Allemann; Julian Gehweiler; Savas Soysal; Raoul Droeser; Silvio Däster; Gabriel Hess; Dimitri Raptis; Otto Kollmar; Markus von Flüe; Martin Bolli; Philippe Cattin

doi:10.3389/fsurg.2022.916443

Magnetic resonance cholangiopancreatography enhanced by virtual reality as a novel tool to improve the understanding of biliary anatomy and the teaching of surgical trainees

Front Surg. 2022 Aug 12:9:916443. doi: 10.3389/fsurg.2022.916443. eCollection 2022.

Authors

Sebastian M Staubli^{1

2}, Peter Maloca^{3

4

5}, Christoph Kuemmerli¹, Julia Kunz⁶, Amanda S Dirnberger¹, Andreas Allemann¹, Julian Gehweiler⁷, Savas Soysal¹, Raoul Droeser¹, Silvio Däster¹, Gabriel Hess¹, Dimitri Raptis², Otto Kollmar¹, Markus von Flüe¹, Martin Bolli¹, Philippe Cattin⁸

Affiliations

¹ Clarunis, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland.
² Clinical Service of HPB Surgery and Liver Transplantation, Royal Free London Hospital, NHS Foundation Trust, London, United Kingdom.
³ Department of Ophthalmology, University of Basel, Basel, Switzerland.
⁴ Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.
⁵ Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
⁶ Faculty of Medicine, University of Basel, Basel, Switzerland.
⁷ Department of Radiology, University Hospital Basel, Basel, Switzerland.
⁸ Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.

Abstract

Objective: The novel picture archiving and communication system (PACS), compatible with virtual reality (VR) software, displays cross-sectional images in VR. VR magnetic resonance cholangiopancreatography (MRCP) was tested to improve the anatomical understanding and intraoperative performance of minimally invasive cholecystectomy (CHE) in surgical trainees.

Design: We used an immersive VR environment to display volumetric MRCP data (Specto VR^TM). First, we evaluated the tolerability and comprehensibility of anatomy with a validated simulator sickness questionnaire (SSQ) and examined anatomical landmarks. Second, we compared conventional MRCP and VR MRCP by matching three-dimensional (3D) printed models and identifying and measuring common bile duct stones (CBDS) using VR MRCP. Third, surgical trainees prepared for CHE with either conventional MRCP or VR MRCP, and we measured perioperative parameters and surgical performance (validated GOALS score).

Setting: The study was conducted out at Clarunis, University Center for Gastrointestinal and Liver Disease, Basel, Switzerland.

Participants: For the first and second study step, doctors from all specialties and years of experience could participate. In the third study step, exclusively surgical trainees were included. Of 74 participating clinicians, 34, 27, and 13 contributed data to the first, second, and third study phases, respectively.

Results: All participants determined the relevant biliary structures with VR MRCP. The median SSQ score was 0.75 (IQR: 0, 3.5), indicating good tolerability. Participants selected the corresponding 3D printed model faster and more reliably when previously studying VR MRCP compared to conventional MRCP: We obtained a median of 90 s (IQR: 55, 150) and 72.7% correct answers with VR MRCP versus 150 s (IQR: 100, 208) and 49.6% correct answers with conventional MRCP, respectively (p < 0.001). CBDS was correctly identified in 90.5% of VR MRCP cases. The median GOALS score was higher after preparation with VR MRCP than with conventional MRCP for CHE: 16 (IQR: 13, 22) and 11 (IQR: 11, 18), respectively (p = 0.27).

Conclusions: VR MRCP allows for a faster, more accurate understanding of displayed anatomy than conventional MRCP and potentially leads to improved surgical performance in CHE in surgical trainees.

Keywords: 3D printing; bile duct anatomy; immersive virtual reality; magnetic resonance cholangiopancreaticography (MRCP); minimally invasive cholec; surgical skills training.