A 53 year-old female presented with a left neck mass. Her past medical history is significant for recurrent breast cancer that required multiple surgeries including radical mastectomy and two courses of chemoradiotherapy. Three years prior to presentation, a mass was found in her left neck. A needle biopsy demonstrated malignant fibrous histiocytoma. Imaging with CT and MRI were obtained and shown in Fig. a, b. Following preoperative physical examination and imaging, VR was used to simulate the operation. The CT and MRI data were collected and converted into DICOM format. The DICOM image was tested to ensure that the image meets quality standards. The DICOM images were used to perform a three dimensional reconstruction of the area of anticipated resection. Multimodal image fusion of CT and MRI was performed using precision detection by medical imaging experts. The multimodal 3D reconstruction model was transformed into VR model, with color coding of important structures, blood vessels, nerves, bone and tumor for convenient recognition. This model is imported into the UE4 engine to take advantage of function customization. After settling cluster rendering equipment and 3D scanner, surgeons wear head mounted display and data gloves for surgical simulation to pick up and rotate the model, or to change functions such as zoom, model resolution, and profile in the virtual operation room (Fig. c). Following use of the VR with multiple sessions, the patient underwent extended excision of left cervical and thoracic junction tumor with partial left clavicle resection, left subclavian vein repair, and pectoralis major myocutaneous flap repair under general anesthesia.
A 17-year-old female patient was admitted to the hospital on September 9, 2019 with abdominal pain that had lasted for half a year and had been worsening for half a month.\nOn September 8, 2019, the patient visited Xiamen Third Hospital for an abdominal US. A homogeneous mass with fluid echo was detected in the left middle abdomen that was suspected as being a retroperitoneal tumor. The patient came to our hospital for further diagnosis and treatment.\nThe patient was in good health with no history of infectious disease, allergy, or surgery.\nThe patient has no family or genetic history of disease.\nA standard physical examination was performed. The abdomen was flat and soft; there was tenderness on the left side but no rebound tenderness and no Murphy’s sign. The mass in the left middle abdomen was about 8 cm × 10 cm in size, with an intact capsule but without a distinct boundary; the mass showed poor mobility with tenderness elicited in the palpation test. The liver and spleen were impalpable under the ribs, and there were no obvious gallbladder abnormalities. Further physical examination revealed drum sounds on percussion, negative shifting dullness, and normal bowel sounds on auscultation.\nNo abnormalities were found in the routine blood, urine and stool analysis, or liver and kidney function.\nA clinical examination after admission on September 9, 2019 revealed sinus arrhythmia by electrocardiography, and a pulmonary nodule in the right lower lobe by helical CT that may have been an old pulmonary lesion. Abdominopelvic enhanced helical CT showed a retroperitoneal space-occupying lesion in the upper left quadrant of the abdomen that was presumed to be retroperitoneal liposarcoma or teratoma (Figure ).\nWe used the proprietary XMQB-Liver software (Xiamen Qiangben Technology Co, Xiamen, China) for 3D reconstruction of CT images. The software allowed rotation, blurring, and elimination of elements in the 3D model (Figure ), provided omnidirectional views (Figure and ), and allowed tumor virtualization (Figure ), removal of normal organs, and observation of the relationship between the tumor, blood vessels, and surrounding organs (Figure ). The tumor was located in the upper left retroperitoneum and was about 11.3 cm × 9.1 cm in size with well-defined borders; it compressed the left renal artery and vein, resulting in vascular displacement and deformation. The inferior vena cava and abdominal aorta were unaffected. The left kidney and adrenal gland were shifted forward and downward under pressure; there was no visible invasion of the liver, spleen, pancreas, or stomach. The intestines could not be reconstructed.