The virtual reality tool VirSSPA in planning DIEP microsurgical breast reconstruction
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The significant variation in the vascular anatomy of the abdominal wall makes preoperative imaging essential when raising a DIEP (deep inferior epigastric artery perforator) flap due to the potential for maximizing operative success, reducing intraoperative error and minimizing operative complications. Variability in perforator anatomy makes DIEP flap surgery a suitable candidate for computer and virtual reality bio models. In this context, a study was undertaken to determine the feasibility of CTA-guided by VirSSPA application. VirSSPA is a virtual reality tool developed in our Hospital for surgical planning and training. This application allows surgeons to generate the three-dimensional (3D) model of the patient.
In this paper, we present a study about VirSSPA tool for virtual reality navigation in DIEP flap surgery and compare findings with operative measurements.
We recruited 12 consecutive patients planned for an elective DIEP flap for breast reconstruction. Each patient underwent preoperative imaging of the anterior abdominal wall vasculature with both conventional CTA and VirSSPA 3D reconstruction. Imaging findings were compared to operative findings.
3D reconstruction of the abdominal wall with VirSSPA demonstrated a significant good correlation with perforator location compared to operative findings, showing an average error rate of 0.228 cm (95% CI, 0.17–0.30). The Pearson product–moment correlation coefficient was found to be 0.99 (p = 0.01), reflecting an almost linear relationship between the two distances, intraoperative and the one measured in the 3D reconstruction.
VirSSPA provides additional and potentially more accurate data over conventional CTA with regard to the site of the best perforators and its course through the muscle for DIEP micro-vascular surgery.
KeywordsCT images Surgical planning Computer-assisted surgery Reconstructive surgical procedures Microsurgery DIEP breast reconstruction
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- 4.Alonso-Burgos A, Garcia-Tutor E, Bastarrika G, Cano D, Martinez-Cuesta A, Pina LJ (2006) Preoperative planning of deep inferior epigastric artery perforator flap reconstruction with multi-slice-CT angiography: Imaging findings and initial experience. J Plast Reconstr Aesthet Surg 59: 585. doi: 10.1016/j.bjps.2005.12.011 PubMedCrossRefGoogle Scholar
- 16.Suárez C, Acha B, Serrano C, Parra C (2008) Improvement of the virtual reality tool VirSSPA used in planning and optimization of surgical processes. CARS 2008 Computer Assisted Radiology and Surgery, BarcelonaGoogle Scholar
- 17.Suárez C, Acha B, Serrano C, Parra C, Gómez-Cía T (2009) VirSSPA—a virtual reality tool for surgical planning workflow. Int J CARS (accepted)Google Scholar
- 19.Smit JM, Dimopoulou A, Liss AG et al (2008) Preoperative CT angiography reduces surgery time in perforator flap reconstruction. J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2007.12.090
- 20.Uppal RS, Casaer B, Van Landuyt K, Blondeel P (2008) The efficacy of preoperative mapping of perforators in reducing operative times and complications in perforator flap breast reconstruction. J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2008.04.015
- 21.Gacto-Sánchez P, Barrera F, Sicilia-Castro D, Miralles F, Collell M, Leal S, De La Higuera J, Parra C, Gómez-Cía T (2008) A three-dimensional virtual reality model for limb reconstruction in burned patients. Burns. doi: 10.1016/j.burns.2008.09.005
- 22.Lawler LP, Fishman EK (2002) CT angiography with multidetector CT data: study optimization, protocol design and clinical applications in the abdomen. Crit Rev Computed Tomogr 43: 77Google Scholar