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Virtual Reality Exploration and Planning for Precision Colorectal Surgery

Guerriero, Ludovica, M.D.1,2; Quero, Giuseppe, M.D.2; Diana, Michele, M.D., Ph.D.2,3; Soler, Luc, Ph.D.2,3; Agnus, Vincent, Ph.D.3; Marescaux, Jacques, M.D., F.R.C.S. (Hon.), F.J.S.E.S. (Hon.), A.P.S.A.2,3; Corcione, Francesco, M.D.1

Diseases of the Colon & Rectum: June 2018 - Volume 61 - Issue 6 - p 719–723
doi: 10.1097/DCR.0000000000001077
Original Contributions: Benign
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BACKGROUND: Medical software can build a digital clone of the patient with 3-dimensional reconstruction of Digital Imaging and Communication in Medicine images. The virtual clone can be manipulated (rotations, zooms, etc), and the various organs can be selectively displayed or hidden to facilitate a virtual reality preoperative surgical exploration and planning.

OBJECTIVE: We present preliminary cases showing the potential interest of virtual reality in colorectal surgery for both cases of diverticular disease and colonic neoplasms.

DESIGN: This was a single-center feasibility study.

SETTINGS: The study was conducted at a tertiary care institution.

PATIENTS: Two patients underwent a laparoscopic left hemicolectomy for diverticular disease, and 1 patient underwent a laparoscopic right hemicolectomy for cancer. The 3-dimensional virtual models were obtained from preoperative CT scans. The virtual model was used to perform preoperative exploration and planning. Intraoperatively, one of the surgeons was manipulating the virtual reality model, using the touch screen of a tablet, which was interactively displayed to the surgical team.

MAIN OUTCOME MEASURES: The main outcome was evaluation of the precision of virtual reality in colorectal surgery planning and exploration.

RESULTS: In 1 patient undergoing laparoscopic left hemicolectomy, an abnormal origin of the left colic artery beginning as an extremely short common trunk from the inferior mesenteric artery was clearly seen in the virtual reality model. This finding was missed by the radiologist on CT scan. The precise identification of this vascular variant granted a safe and adequate surgery. In the remaining cases, the virtual reality model helped to precisely estimate the vascular anatomy, providing key landmarks for a safer dissection.

LIMITATIONS: A larger sample size would be necessary to definitively assess the efficacy of virtual reality in colorectal surgery.

CONCLUSIONS: Virtual reality can provide an enhanced understanding of crucial anatomical details, both preoperatively and intraoperatively, which could contribute to improve safety in colorectal surgery.

1 Department of General, Laparoscopic and Robotic Surgery, Monaldi Hospital, Azienda Ospedaliera di Rilievo Nazionale dei Colli, Naples, Italy

2 Institute of Image-Guided Surgery, Strasbourg, France

3 Research Institute Against Cancer of the Digestive System, Strasbourg, France

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (

Funding/Support: None reported.

Financial Disclosure: Dr Soler reports grants from BPI France during the conduct of the study and personal fees from Visible Patient S.A.S. outside of the submitted work. Dr Marescaux is the president of both the Research Institute Against Cancer of the Digestive System and the Institute of Image-Guided Surgery, which are partly funded by Karl Storz, Medtronic, and Siemens Healthcare.

Presented at the meeting of the 2017 European Association of Endoscopic Surgery, Frankfurt am Main, Germany, June 14 to 17, 2017.

Correspondence: Michele Diana, M.D., Ph.D., 1 Porte de l’Hopital, 67091 Strasbourg Cedex, France. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons