Virtual Reality for Preoperative Planning and Education in Pediatric Surgery: Preliminary Results for the Treatment of Congenital Malformations and Tumors

Abstract

Purpose: Virtual reality (VR) has emerged as a valuable tool in surgical planning, offering detailed anatomical spatial orientation and three-dimensional (3D) navigation. This study explores using virtual reality head-mounted display (VR-HMD) technology in preoperative planning for pediatric surgery, aiming to improve outcomes in treating congenital malformations and tumors while advancing surgical education.

Methods: A retrospective analysis was performed on pediatric patients diagnosed with congenital malformations and tumors who received treatment between 2021 and 2024 at the "V. Buzzi" Children's Hospital in Milan, Italy. Patient-specific 3D VR models were generated from reconstructed computed tomography/magnetic resonance imaging (CT/MRI) images and analyzed preoperatively to optimize surgical planning and strategy development. The advantages of preoperative VR compared to traditional imaging techniques were assessed.

Results: Fifty VR models were included in the study (n = 35: congenital malformations and n = 15 tumors). The VR-HMD setup facilitated interactive anatomical exploration, enabling precise surgical navigation and planning. Compared to conventional imaging, preoperative VR simulations modified the surgical approach in 75.0% of cases, enabling minimally invasive strategies in complex congenital malformations and guiding the decision for open surgery in anatomically challenging tumors such as adrenal and hepatic masses. VR images demonstrated superior anatomical resolution and identified potential intraoperative complications in 92.0% of cases compared to conventional imaging. Remarkably, examining the vascular hilum in pulmonary, hepatic, and renal structures provided enhanced guidance for determining the surgical approach, ensuring a safer and more precise respect for the anatomy in complex cases. As a result, preoperative VR navigation demonstrated the feasibility of minimally invasive procedures in 45.6% of complex cases whereas recommending an open surgical approach in 55.4% of the models. Limitations in visualizing urological structures (e.g., ureters and bladder in complex urogenital malformations) limited the VR's utility in those cases, underscoring the need for future advancements in segmentation and multimodal imaging to enhance anatomical accuracy.

Conclusion: Preoperative VR enables customized surgical planning, potentially minimizes intraoperative risks, and provides valuable educational opportunities for pediatric surgical teams. Future advancements in VR technology promise to further enhance its integration into clinical practice, ultimately improving pediatric patients' outcomes.

Keywords: congenital malformations; education; pediatric surgery; preoperative simulation; tumors; virtual reality.

FIGURE 1

Integration of virtual reality (VR) technology into the surgical workflow. The surgical team uses VR head‐mounted displays (HMDs) and interactive screens for preoperative planning and intraoperative guidance, enhancing precision and collaboration during complex procedures.

FIGURE 2

Multimodal imaging and intraoperative views of congenital pulmonary airway malformation (CPAM). (a) VR reconstructed anatomical visualization of CPAM, highlighting airway anomalies with a yellow marker indicating the segmental region of interest; (b) Axial CT scans illustrating the abnormal pulmonary architecture and presence of a cystic lesion consistent with CPAM; (c) Intraoperative photo depicting the gross appearance of the malformation during surgical resection, showcasing vascularity and cystic structure.

FIGURE 3

Multimodal imaging and intraoperative views of an intralobar sequestration: (a) Virtual reality (VR) reconstruction showing intralobar sequestration with vascular hyperafflux (highlighted in pink) and associated cystic malformation (highlighted in purple). (b) CT scan illustrating the pulmonary malformation with abnormal vascularization and cystic architecture. (c) Intraoperative view of the afferent arterial vessel from the aorta supplying the pulmonary sequestration. (d) Intraoperative view during a left lower pulmonary lobectomy; isolation of the lower bronchus (*) and ligation of vascular structures.

FIGURE 4

Multimodal representation of the right adrenal neuroblastoma: (a) VR reconstructed anatomical visualization showing the tumor's spatial relationship with adjacent organs and artery distribution, highlighted with a yellow marker and (b) coronal CT scan demonstrating the large abdominal mass with heterogeneous density, indicative of its complex nature and involvement with surrounding tissues.