Preparing for the future of cardiothoracic surgery with virtual reality simulation and surgical planning: a narrative review

Background and Objective: Virtual reality (VR) technology in cardiothoracic surgery has been an area of interest for almost three decades, but computational limitations had restricted its implementation.Recent advances in computing power have facilitated the creation of high-fidelity VR simulations and anatomy visualisation tools.We undertook a non-systematic narrative review of literature on VR simulations and preoperative planning tools in cardiothoracic surgery and present the state-of-the-art, and a future outlook.Methods: A comprehensive search through MEDLINE database was performed in November 2022 for all publications that describe the use of VR in cardiothoracic surgery regarding training purposes, education, simulation, and procedural planning.We excluded papers that were not in English or Dutch, and that used two-dimensional (2D) screens, augmented, and simulated reality.Key Content and Findings: Results were categorised as simulators and preoperative planning tools.Current surgical simulators include the lobectomy module in the LapSim for video assisted thorascopic surgery which has been extensively validated, and the more recent robotic assisted lobectomy simulators from Robotix Mentor and Da Vinci SimNow, which are increasingly becoming integrated into the robotic surgery curriculum.Other perioperative simulators include the CardioPulmonary VR Resuscitation simulator for advanced life support after cardiac surgery, and the VR Extracorporeal Circulation (ECC) simulator for perfusionists to simulate the use of a heart-lung machine (HLM).For surgical planning, there are many small-scale tools available, and many case/pilot studies have been published utilising the visualisation possibilities provided by VR, including congenital cardiac, congenital thoracic, adult cardiac, and adult thoracic diseases.Conclusions: There are many promising tools becoming available to leverage the immersive power of VR in cardiothoracic surgery.The path to validate these simulators is well described, but large-scale trials producing high-level evidence for their efficacy are absent as of yet.Our view is that these tools will become increasingly integral parts of daily practice in this field in the coming decade.