縦隔・胸壁に対する胸腔鏡下手術におけるバーチャルリアリティを用いたポート位置のシミュレーション

Preoperative Virtual Reality Simulation Regarding the Appropriate Port Location for Thoracoscopic Surgery for the Mediastinal or Chest Wall Lesions

定型的な胸腔鏡下肺切除術では，体位やポート位置はある程度標準化されている．しかし，縦隔や胸壁疾患では個々の患者で対象の位置が異なるため，それらに応じた適切なポート位置が要求される．

In thoracoscopic surgery for mediastinal or chest wall lesions the suitable position of ports （trocars） are required depending on the position of a target lesion in a particular patient. We have therefore developed a virtual reality （VR） simulation system using the specific data of each individual patient. The model data generation system, PASS-GEN, is customized for thoracic surgery. The chest wall and organs around the tumor are extracted from DICOM image data of computed tomography （CT） scan, and three-dimensional （3D） virtual images are constructed. Rehearsal of ports insertion is carried out by locating the scope and the forceps anywhere on the chest wall on PC monitor. The constructed VR images clearly show three dimensional relationships between the target and surrounding structures. This system also simulates circumstances where on the chest wall a thoracoscope and tools should be inserted for the better view and more comfortable manipulation. Particularly in mediastinal or chest wall surgery VR simulation is more practical because those structures would be less transformed during operation.