Virtual Surgical Planning - An Insight

What Is Virtual Surgical Planning?

Virtual surgical planning, or VSP, is a technique in surgery that uses computerized tools to model surgical procedures, visualize patient anatomy, and forecast results. It is increasingly being implemented to enhance accuracy, productivity, and communication in several surgical disciplines, including craniofacial, orthognathic, and reconstructive surgery.

What Are the Key Steps in Virtual Surgical Planning?

• 3D Data Acquisition: First, 3D (three-dimensional) data must be acquired using 3D cone-beam CT (computerized tomography) scans or 3D stereophotogrammetry.

• Landmark Selection and Data Alignment: Selecting anatomical landmarks is also important in converting manual or automated clinical data into virtual objects. Data alignment is also included to compare pre-and post-operative setups perfectly.

• Predictive Modeling: The use of data-driven, hybrid, or model-based modeling techniques in the design of special equipment and procedures and in predicting surgical outcomes.

• Surgical Procedures Simulation: Simulation of osteotomies and pre-surgical reconstruction plans assists in better visualization of the pathologic circumstance as well as the anatomy of the patient.

• Planning and Communication: The aim is to enhance the communication of the patient-surgeon team and establish useful benchmarks for accurate surgical planning.

What Are the Benefits of Virtual Surgical Planning?

• Accuracy and Precision: The virtual surgical planning software is quite exact and reproducible for orthognathic surgery since most patients are successful when the mean difference is set at 2 mm as the success criterion. VSP can produce more symmetrical frontal views; the precision of its soft tissue prediction is higher. VSP reduces intraoperative errors during craniofacial surgery and enhances the precision of osteotomies.

• Preoperative Planning and Visualization: VSP allows the visualization of patient anatomy and pathologic circumstances in great detail, making preoperative simulation of osteotomies and reconstruction designs possible. This will help design cutting guides and templates to reduce intraoperative errors and give preoperative insight into surgical procedures.

• Efficiency and Time Management: When used with computer-assisted splints, VSP reduces operational time and saves overall time in the preoperative stages. However, some additional time is spent on software planning. VSP, coupled with 3D virtual surgical planning and printing, allows for effective surgical workflows and has recorded some successful outcomes in craniomaxillofacial surgeries.

• Technological Integration: VSP combines two imaging modalities, cone-beam CT scans and 3D stereophotogrammetry, to collect 3D data for diagnosis and treatment planning. It is generally combined with 3D printing, computer-assisted design, and manufacturing to create special surgical instruments and devices.

• Communication and Collaboration: VSP improves communication between surgical teams and their patients by clearly understanding what is intended and what results can be expected. It also improves surgeons' and engineers' collaboration; however, there still needs to be more friction in successful management, represented by poor communication and assessment of anatomy.

In Which Surgeries Virtual Surgical Planning Is Used?

• Orthognathic Surgery: VSP increases performance and precision by enhancing preoperative understanding and reducing intraoperative mistakes. This results in more symmetric results and provides higher accuracy in predicting soft tissues.

• Craniofacial Surgery: VSP is useful in craniofacial skeleton microsurgery, traumatic, orthognathic, and cranio-orbital procedures. It offers more predictable results for intraoperative guidance and custom permanent implants in treatment.

• Reconstructive Surgery: VSP will be useful in precision-guided oncology, dental implant placement, delayed reconstruction, and maxillary reconstruction. It is especially useful in microsurgery, where it substantially facilitates the preparation and execution of complex reconstructions.

• Veterinary Oral Maxillofacial Surgery: In veterinary medicine, virtual surgical planning in oral and maxillofacial surgery uses VSP and 3D printing as useful tools that enhance the learning process and the three-dimensional visualization of anatomy, with probable reduction of surgical time and increased precision.

• Liver Tumor Resections: VSP facilitates the planning of intricate liver tumor resections, especially when virtual reality improves spatial comprehension of individual anatomical elements.

What Is the Accuracy of Virtual Surgical Planning?

• Generally, VSP has proven dependable and accurate in orthognathic treatment planning. Most reports indicate less than a 2 mm average difference between the intended and actual outcomes. Considering frontal symmetry, VSP is more accurate than traditional planning methods.

• In reconstructive mandible surgery, VSP is more accurate than conventional free-hand surgery compared to traditional approaches, with fewer mean variances regarding the gonion angle (angle of the mandible) and intercondylar distance.

• There is no significant difference in the accuracy of VSP and TSP (trochanter stabilization plate) for hard tissue in the sagittal plane. However, at some reference locations, mostly on the anterior maxilla, VSP was more accurate. The latter raises the maxilla's positioning, and the VSP's accuracy is similar.

• Compared to free-hand surgery, VSP saves time during the operation and ischemia; however, initial preparation with the software requires more time.

• When the entire process is factored in, VSP can save much preoperative and operational time.

• In soft tissue and frontal symmetry prediction, VSP results in a more symmetrical frontal view and enhances the precision in soft tissue prediction in the sagittal plane.

What Are the Risks Associated With Virtual Surgical Planning?

These plans were abandoned due to the following reasons:

• Poor communication between the engineer and the surgeon.

• Poor acknowledgment of the positioning of condyles on pre-operative scans.

• Soft tissue interference with bone movement.

• The fast-paced growth of the tumor.

• Poor preoperative analysis of anatomy.

In short, despite the usefulness of virtual surgical planning in orthognathic and craniofacial surgery, the surgeon must be aware of its intrinsic problems. Over time and with practice, these surgical plans can become useful adjuncts to proper clinical judgment.

Conclusion

The research demonstrates that, through digital data for diagnosis, treatment planning, and the creation of models and guides, VSP represents a sophisticated, non-invasive technology applied in various surgical specialties to achieve precision with speed. Since surgeons began adopting VSP for selected surgeries, this technology has made much difference. Though surgeons currently use VSP mainly for surgeries involving the skull and face bones, the application could extend to other areas. While VSP will avoid surgical complications and save time for the surgery, it is a very expensive operation that can take some time. Before doing so, discuss the pros and cons of seeking imaging for VSP with the surgeon.