Thoracoscopic surgery for congenital pulmonary malformations in infants: a preliminary comparative evaluation of virtual reality-guided preoperative planning versus standard imaging.

BACKGROUND

Thoracoscopic resection of congenital pulmonary malformations remains technically demanding because of limited working space, variable broncho-vascular anatomy and the need to preserve healthy lung parenchyma. An integrated workflow combining patient-specific three-dimensional (3D) segmentation with immersive virtual reality (VR) navigation may enhance preoperative planning, but clinical data remain limited.

METHODS

We performed a retrospective historical cohort study of children undergoing thoracoscopic resection between 2013 and 2024. Patients were grouped according to planning strategy: standard imaging (SI) alone or an additional integrated workflow combining patient-specific 3D segmentation with immersive VR navigation (VR). Perioperative outcomes were compared, with focused analyses of lesion and procedure heterogeneity and chronological effects.

RESULTS

Fifty infants were analyzed (39 SI, 11 VR). Median operative time was 183 versus 248 min (p = 0.42). Conversion occurred in 10/39 SI cases and no VR cases (p = 0.045); intraoperative complications occurred in 5/39 and 0/11 (p = 0.20), and postoperative complications in 6/39 and 0/11 (p = 0.16). Median NICU/PICU stay was 2 versus 1 day (p = 0.045), and hospital stay 8 versus 5 days (p < 0.001). Three SI patients required redo surgery and no VR patients did. Findings showed substantial case-mix heterogeneity, but their favorable direction was maintained in focused analyses. VR cases occurred later in the institutional experience.

CONCLUSIONS

The integrated VR-guided workflow was feasible and associated with favorable perioperative signals. Although the historical design precludes causal attribution, the consistency of these preliminary findings supports prospective evaluation of VR as a patient-specific planning adjunct.