Background

The surgical management of Hepato-Pancreato-Biliary (HPB) cancer poses significant challenges, primarily due to the complexity of patients. However, the role of stereopsis (depth perception) in visualizing three-dimensional (3D) anatomical models remains relatively underexplored. Integrating stereoscopic technologies with 3D anatomical modelling holds promise for enhancing surgical planning and navigation, thereby addressing the inherent complexities of HPB surgeries.

Aim
This study aims to evaluate the effect of stereopsis on the preoperative surgical planning of colorectal liver metastases surgery.

Methods
A retrospective study was conducted with participants from the Department of Surgery, Leiden University Medical Centre (LUMC), to investigate the occurrence and severity of symptoms resulting from the use of a stereoscopic display. Subsequently, liver and transplant surgeons from the same department participated in another retrospective study comparing surgical plans for colorectal liver metastases performed stereoscopically with those performed monoscopically, within the same surgeon.

Results
14 out of 18 participants experienced (slight) symptoms from the use of a stereoscopic display, yet no one discontinued the study due to symptoms. In the subsequent study on the effect of stereopsis on preoperative surgical planning for colorectal liver metastases, 13 liver and transplant surgeons participated. Relative to a gold standard, there appears to be no significant difference between surgical plans executed monoscopically or stereoscopically. There is also no significant difference in the time taken to create these surgical plans (p=0.401). Despite the absence of significant difference between the plans, surgeons do express a (strong) preference for stereopsis in locating the tumor (61%), determining the surgical plan (61%), and assessing vascular involvement (69%).

Conclusion
It is evident that surgeons have a preference for stereopsis in visualizing 3D models, although our study found no discernible differences in outcomes between monoscopic and stereoscopic preoperative planning for colorectal liver metastases surgery. Future research is recommended to compare surgical plannings based on conventional two-dimensional imaging alone with conventional two-dimensional imaging supplemented by additional stereoscopic 3D models. This comparative analysis could offer further insights into the potential advantages of integrating stereoscopic technology into preoperative planning practices.