Comparing a virtual reality head-mounted display to on-screen three-dimensional visualization and two-dimensional computed tomography data for training in decision making in hepatic surgery: a randomized controlled study

Objective Evaluation of the benefits of a virtual reality (VR) environment with a head-mounted display (HMD) for decision-
making in liver surgery.
Background Training in liver surgery involves appraising radiologic images and considering the patient’s clinical information.
Accurate assessment of 2D-tomography images is complex and requires considerable experience, and often the images are
divorced from the clinical information. We present a comprehensive and interactive tool for visualizing operation planning
data in a VR environment using a head-mounted-display and compare it to 3D visualization and 2D-tomography.
Methods Ninety medical students were randomized into three groups (1:1:1 ratio). All participants analyzed three liver
surgery patient cases with increasing difficulty. The cases were analyzed using 2D-tomography data (group “2D”), a 3D
visualization on a 2D display (group “3D”) or within a VR environment (group “VR”). The VR environment was displayed
using the “Oculus Rift ™” HMD technology. Participants answered 11 questions on anatomy, tumor involvement and surgi-
cal decision-making and 18 evaluative questions (Likert scale).
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Results Sum of correct answers were significantly higher in the 3D (7.1 ± 1.4, p < 0.001) and VR (7.1 ± 1.4, p < 0.001)
groups than the 2D group (5.4 ± 1.4) while there was no difference between 3D and VR (p = 0.987). Times to answer in the
3D (6:44 ± 02:22 min, p < 0.001) and VR (6:24 ± 02:43 min, p < 0.001) groups were significantly faster than the 2D group
(09:13 ± 03:10 min) while there was no difference between 3D and VR (p = 0.419). The VR environment was evaluated as
most useful for identification of anatomic anomalies, risk and target structures and for the transfer of anatomical and patho-
logical information to the intraoperative situation in the questionnaire.
Conclusions A VR environment with 3D visualization using a HMD is useful as a surgical training tool to accurately and
quickly determine liver anatomy and tumor involvement in surgery.