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Pre-operative simulation and surgical navigation in minimally invasive cardiac surgery using virtual reality and individualized 3 dimentional model.
Takashi Murakami, Mitsuharu Hosono, Masanori Sakaguchi, Akimasa Morisaki, Yasuo Suehiro, Shinsuke Nishimura, Yoshito Sakon, Daisuke Yasumizu, Takumi Kawase, Toshihiko Shibata.
Osaka City university Graduate School of Medicine, Osaka, Japan.

OBJECTIVE: Operative field is limited in minimally invasive cardiac surgery (MICS). To increase the safety and quality of the operative procedure, we developed the virtual reality of the patient’s anatomy for pre- and intra-operative navigation. Furthermore, 3D model of the patient’s heart valve is made and simulation of the procedure was conducted.
METHODS: METHOD1: Form the cardiac CT data, segmentation of the tissues or organs were made seperately, such as a skin, a bone, a heart, coronary arteries, epicardial fat, and so on, and virtual realistic anatomy was made using 3D computer graphics (3DCG) software. Assessment and simulation was made using this 3D computer graphics, in terms of the incision site for best exposure, intra-cardiac view for valve surgery, coronary artery anatomy in relation to other cardiac anatomy and fatty tissue for MICS coronary bypass surgery, and papillary muscle anatomy for anchoring the artificial chordae for mitral valve repair.
METHOD 2: Using 3D model of the diseased aortic valve, simulation of aortic valve replacement (AVR) was performed before the AVR.
RESULTS: Virtual reality model made by 3DCG software and 3D model was useful for the planning of the surgical procedure. It was also used as a navigation during surgery. When the orifice of the right coronary artery could not be recognized, preoperative graphics guided the tip of coronary cannula. During MICS CABG, anastomosis site was easily recognized by the graphics guide. Details of the surgical procedure was considered during the simulation operation on the 3D model.
CONCLUSIONS: Our navigation method was useful in MICS in increasing the safety and quality of the surgical procedures.


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