Virtual 3D models, augmented reality systems and virtual laparoscopic simulations in complicated pancreatic surgeries: state of art, future perspectives, and challenges

Abstract

Pancreatic surgery is considered one of the most challenging interventions by many surgeons, mainly due to retroperitoneal location and proximity to key and delicate vascular structures. These factors make pancreatic resection a demanding procedure, with successful rates far from optimal and frequent postoperative complications. Surgical planning is essential to improve patient outcomes, and in this regard, many technological advances made in the last few years have proven to be extremely useful in medical fields. This review aims to outline the potential and limitations of 3D digital and 3D printed models in pancreatic surgical planning, as well as the impact and challenges of novel technologies such as augmented/virtual reality systems or artificial intelligence to improve medical training and surgical outcomes.

Figure 1.

(A) CT scan of the patient); (B) intraoperative image after tumoral resection, with intact SMA, PV, superior mesenteric artery, and IVC; (C) Tumoral relationship with arterial vessels, veins, and portal vein. Images A, B, and C extracted from^[11]; (D) CT scan showing Bühler anastomosis. Red arrow: vascular variant; green arrow: stent in the hepatic duct; (E) digital 3D model showing the Bühler anastomosis. Images D and E extracted from^[28].

Figure 2.

Cinematic rendering of peripancreatic organs and arterial vessels. Image obtained from^[34].

Figure 3.

(A) Axial CT scan and (B) sagittal CT scan of a pancreatic cancer patient. Organs; (C) 3D printed model of patient’s anatomy. Image modified from^[38].

Figure 4.

(A) and (B) Digital 3D model of patient’s anatomy with different levels of transparency; (C) Intraoperative image of the surgical field; (D) Overlapping of digital model and real image. Image modified from^[21].

Figure 5.

(A) Intraoperative view of surgical field and model registration using a QR code (image obtained from^[72]); (B) intraoperative view of surgical field and model registration using anatomical markers (image obtained from^[76]); (C) Landmark identification in a CT scan, ultrasound and 3D model (image obtained from^[77]).