Individualised Liverresection Planning using 3D printing and Virtual Reality (i-LiVR)

• Applicant: Privatdozent Dr. Tobias Huber
• Subject Area: General and Visceral Surgery
• Term: since 2022
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 490729183

Every year, around 30,000 patients with malignant liver tumors or metastases are operated on in the liver in Germany. The technical as well as functional resectability in the context of curative therapy approaches describes the possibility of complete tumor removal while preserving a sufficiently large residual liver volume. The liver is a highly perfused parenchymal organ that can pose major technical challenges for surgeons. This is reinforced by the enormous individual variability of the vascular anatomy. Performing liver resections therefore requires precise preoperative planning of the procedure. This is currently done using slice imaging (CT or MRI) presented as a two-dimensional datasets. The three-dimensional transformation is usually carried out by the imagination of the surgeon. Computer-based procedures offer the possibility of 3D reconstruction. These 3D reconstructions are usually displayed as an interactive PDF file on a conventional screen. 3D printing now enables planning with the help of a 3D model of the liver. Organ models can also be represented using the techniques of virtual reality. A specially developed application enables the virtual representation of an individual 3D liver reconstruction. A versatile and simultaneous interaction is also possible with several users. The effects of the different 3D presentation modalities for the surgical team on the surgical planning as well as the postoperative course have not been investigated so far. The proposed project represents a monocentric clinical study in which the above-mentioned forms of presentation are used randomly in the context of liver surgery. The anatomy is demonstrated to the surgical team within 48 hours prior to liver surgery. Patients are randomized into one of 4 groups: control group; 3D PDF; 3D printing; 3D virtual reality. The preoperatively available sectional images are available in all groups. The main question is the changes in the planned resection volume as well as the preference of the surgical team. Intra- and postoperative data as well as complications are also analyzed. The innovation of the project lies in the first clinical evaluation of several three-dimensional forms of presentation for planning the operation before liver surgery. Due to the great expertise in the scientific and clinical focus on liver surgery and surgical simulation and the excellent cooperation with computer scientists, this represents a unique feature of the project group. The areas of individualized oncological medicine on the one hand and the development and use of modern technologies such as 3D printing or virtual reality on the other has a high innovation potential in surgery.

• DFG Programme: Research Grants