Journal Article

Patient-specific virtual surgical simulation: the preliminary exploration of surgical evaluation for difficult pediatric liver tumors

Zhang, Jingli, Xiu, Wenli, Yang, Chenyu, Borgioli, Leonardo, Zhou, Xianjun, Zhu, Rongkun, Liu, Jie, Dong, Qian, Jia, Shiyu, Yu, Lun, Chen, Jiatong, Wang, Feifei, Ducas, Alvaro, Wang, Kai

2025

Overview

Background The surgical evaluation of pediatric liver tumors is challenging, especially in difficult cases that require precise surgery. Three-dimensional visualization (3D) based on two-dimensional CT (2D) has been widely used. However, virtual surgical simulation (VS), which can provide more procedural details for specific patients, is worthy of further exploration. Methods Six pediatric liver tumor patients with the surgical difficulty increasing sequentially were selected. Recruited pediatric surgeons (15 junior and 15 senior) guided professional technicians in performing surgical evaluation using 2D, 3D, and VS sequentially. The patient-specific VS based on 3D can be constructed within the clinically permissible time window to meet clinical needs. Results For objective analysis, the scores in 3D Group and VS Group were significantly higher than those in 2D Group ( P  < 0.0001), and there was also a statistically significant difference between 3D Group and VS Group ( P  < 0.0001). As the difficulty increased, the 3D Group and VS Group consistently maintained higher scores. The scores of Junior Group using 2D were significantly lower than those of Senior Group ( P  < 0.0001), but there was no significant statistical difference in the scores of using 3D and VS. For subjective assessment, the scores of 3D Group and VS Group were significantly higher than those of 2D Group ( P  < 0.0001). VS was more aligned with clinical reality compared to 3D. Conclusion 3D and VS offer significant advantages in surgical evaluation compared with 2D, particularly for difficult cases and junior surgeons. The novel perspective and realistic experience provided by VS have attracted attention, and future research will further validate its potential clinical value in preoperative rehearsals and advanced training.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Chemotherapy / Child / Child, Preschool / Clinical Competence / Computer Simulation / Decision making / Female / Females / Hepatectomy - education / Hepatectomy - methods / Humans / Imaging, Three-Dimensional / Internal Medicine / Laparoscopy / Liver / Liver cancer / Liver Neoplasms - diagnostic imaging / Liver Neoplasms - surgery / Liver surgery / Liver tumors / Male / Medicine / Medicine & Public Health / Patients / Pediatric liver tumor / Pediatrics / Realism / Simulation / Simulation Training - methods / Statistical analysis / Subjective assessment / Surgeons / Surgery / Surgical evaluation / Technicians / Telesurgery / Three-dimensional visualization / Tomography, X-Ray Computed / Training / Tumors / Veins & arteries / Virtual Reality / Virtual surgical simulation