With Joseph Shirk, MD, of the David Geffen School of Medicine and the Jonsson Comprehensive Cancer Center at UCLA
By Sarah DiGiulio
Virtual reality technology has for a while been touted as holding all sorts of benefit for medical outcomes. Now new research shows that, when used to help cancer surgeons prepare for kidney tumor surgeries, the technology not only works, but also leads to superior outcomes compared with using the current standard CT and MRI scans.
The study published in JAMA Network Open analyzed outcomes of 92 people with kidney tumors who had surgeries to remove those tumors at six different hospitals (all were large teaching hospitals) (2019; doi: 10.1001/jamanetworkopen.2019.11598). Of the group, 48 individuals had surgeries for which surgeons prepared by using conventional methods, and 44 had surgeries for which surgeons prepared by reviewing both conventional CT and MRI scans, as well as 3D virtual reality models (which could be viewed with mobile phones or with a virtual reality headset). The patients in the latter groups had better postoperative outcomes, including shorter operating times, less blood lost during surgery, and shorter postoperative hospital stays.
"Visualizing the patient's anatomy in a multicolor 3D format, and particularly in virtual reality, gives the surgeon a much better understanding of key structures and their relationships to each other," noted the study's lead author Joseph Shirk, MD, a clinical instructor in urology at the David Geffen School of Medicine at UCLA and at the UCLA Jonsson Comprehensive Cancer Center. "This study was for kidney cancer, but the benefits of using 3D models for surgical planning will translate to many other types of cancer operations, such as prostate, lung, liver, and pancreas."
Importantly, this research shows that, not only do 3D virtual reality models help surgeons better prepare for surgery and better understand their patients' specific anatomies, but the technology actually improves patient outcomes, too.
"Actually seeing evidence of this magnitude, generated by very experienced surgeons from leading medical centers, is an entirely different matter. This tells us that using 3D digital models for cancer surgeries is no longer something we should be considering for the future—it's something we should be doing now," he stated. In an interview with Oncology Times, Shirk shared his thoughts about the new findings.
1. What were the key findings from the study?
"We conducted a multi-institution, randomized, controlled trial comparing surgeries performed for the removal of a kidney tumor using the current standard of care [reviewing CT or MRI images only] versus surgeries performed using CT and MRI [images], plus the virtual reality model. We looked at the outcomes that define a successful surgery: operating time, blood loss, clamp time (a measure of how long this kidney is deprived of oxygen), and length of hospital stay.
"The use of these 3D virtual reality models reduced operative time, blood loss, and clamp time—and shortened length of hospital stay. This means that using the models for this type of surgery led to better surgeries being performed.
"We achieved the sample size that we had calculated prior to initiating the trial, so the number of cases is sufficient to ensure the results are highly accurate."
2. Can you explain how the models work: how did the physicians view the 3D models and is it feasible that this type of technology can be scaled up to be used more widely by all hospitals?
"The models were made from the CT or MRI scan. The physicians were able to view the models on the screen of a smartphone or iPad, or using an off-the-shelf virtual reality headset for the full virtual reality experience. The entire model was in virtual reality.
"Yes, I do [think it's feasible to use this type of technology more widely in different sized hospitals across the country]. And the reason is that the only hardware required is a smartphone and an off-the-shelf virtual reality headset. The technology is now commercially available and should be easy to adopt at all kinds of hospitals."
3. So what do these findings mean for the future of using 3D virtual reality models in cancer surgery prep?
"The study shows that 3D virtual reality models used for kidney cancer surgeries improved patient outcomes. This should certainly change clinical practice and quickly become the new gold standard for surgical planning. Surgeons are very motivated to improve outcomes, and patients will likely ask for their surgeon to use the technology once they are aware it is the new state of the art.
"The next step is to examine the impact of the models on other types of cancer surgeries. Any surgery performed on a solid organ to remove a tumor should benefit from using this technology.
"Advanced visualization of patient anatomy in the operating room is the future of surgery. Based on the results of this study, this type of technology can help surgeons provide better care to cancer patients."