Interactive virtual reality for planning esophageal surgery

Esophageal surgery demands a precise understanding of anatomy, pathology and tumour extent before a patient enters theatre. Conventional CT, PET and endoscopy remain central, yet they often require clinicians to mentally reconstruct three-dimensional relationships from separate images. Interactive virtual reality (VR) can make that reconstruction more intuitive.

A VR planning platform converts medical imaging into a navigable anatomical model. Surgeons can inspect the oesophagus, stomach, mediastinum, lymph nodes and nearby vessels from different angles, while adjusting transparency, isolating structures or simulating the planned operative approach. This creates a shared visual reference for complex cases.

For Australian clinicians, these tools are relevant to multidisciplinary teams working across major centres in Sydney, Melbourne, Brisbane, Perth and Adelaide. They may also support discussion with patients referred from regional hospitals, where travel, specialist availability and coordinated decision-making can influence the timing of treatment.

The ISDE 2021 virtual congress provided an international setting for examining advances in esophageal disease, education and surgical practice. Its scientific sessions and digital format reflected a wider shift towards remote collaboration, a change that remains valuable for Australian hospitals managing large distances and uneven access to subspecialty expertise.

Building a patient-specific surgical model

A useful system begins with high-quality CT or MRI data, often combined with PET, endoscopy reports and pathology. Segmentation software identifies relevant structures and turns them into a volumetric model. The surgeon can then review the relationship between a lesion and the airway, aorta, pulmonary vessels, gastric conduit or regional lymph nodes.

The model is most valuable when it answers a specific clinical question. For example, a team may examine whether a tumour appears to encroach on adjacent tissue, assess the length of a gastric pull-up, or plan port placement for minimally invasive surgery. VR does not replace radiology or operative judgement; it adds an interactive layer to established interpretation.

Supporting multidisciplinary decisions

Complex esophageal cases commonly involve upper gastrointestinal surgeons, gastroenterologists, radiologists, oncologists, anaesthetists, pathologists and specialist nurses. A shared three-dimensional view can reduce ambiguity during tumour board meetings and make the reasoning behind a proposed procedure easier to follow.

This is particularly useful when clinicians are joining remotely. A team in a metropolitan hospital can review the same digital anatomy with a referring service in regional New South Wales or Queensland. Sessions scheduled across Australian time zones still require planning, but a virtual model can make the discussion more focused than exchanging static screenshots by email.

Features that improve planning value

The strongest platforms combine visual clarity with clinical control. Important capabilities include:

• Layered display of organs, vessels, airways and lymphatic regions
• Measurements for distances, angles and conduit length
• Annotation tools for marking margins, lesions and operative landmarks
• Compatibility with standard imaging formats and hospital systems

A headset is not always essential. Desktop three-dimensional viewers and large-screen displays may be more practical for a ward meeting, while immersive headsets can offer greater spatial awareness during rehearsal. Australian hospitals must also consider device cleaning, infection-control procedures, staff training and the availability of reliable hardware.

Rehearsing approaches before theatre

Immersive simulation allows a surgeon to explore the operative corridor before the procedure. In a thoracoabdominal or transhiatal approach, the team can review the sequence of exposure, identify structures at risk and discuss alternatives if the anatomy differs from expectations.

VR rehearsal may also support teaching. Trainees can study a de-identified model and receive guidance from an experienced surgeon without using theatre time. In Australia, where specialist training is distributed across public hospitals, private facilities and regional networks, this can supplement face-to-face instruction while preserving the importance of supervised clinical experience.

Governance, evidence and Australian practice

Clinical adoption requires more than impressive graphics. Teams should assess segmentation accuracy, image quality, workflow integration and whether the software has an appropriate regulatory pathway. Products used in Australia may require review against Therapeutic Goods Administration requirements, along with local information-security and procurement policies.

Patient privacy is equally important. Imaging data should be de-identified where possible, stored securely and handled under Australian privacy obligations and hospital governance rules. A VR demonstration should never expose identifiable scans in a public exhibition or informal teaching environment. Vendors also need to explain where data is processed and whether it leaves Australia.

The evidence base is developing. Current benefits are most plausible in communication, spatial understanding, education and selected preoperative planning tasks, while effects on complications, operating time and long-term outcomes require stronger comparative research. Australian surgeons documenting educational activity should also check how participation aligns with Royal Australasian College of Surgeons continuing professional development requirements.

Connecting congress learning with clinical workflows

Virtual congress content can help clinicians compare approaches, review emerging research and identify practical questions for their own hospitals. Sessions on imaging, minimally invasive techniques, simulation and patient-centred communication are especially relevant when evaluating a VR planning programme.

Implementation is more likely to succeed when it begins with a small number of carefully chosen cases. A hospital might start with locally advanced tumours, reoperative anatomy or unusual vascular relationships, then collect feedback from surgeons, radiologists, nurses and patients. Clear measures could include planning time, changes to the operative plan, team confidence and technical problems.

Cost is another consideration in the Australian market. A service may involve software licensing, imaging integration, headsets, support and cybersecurity review rather than a single purchase price. Public hospitals in Victoria or New South Wales may follow formal capital and digital-health procurement processes, while private groups may prioritise interoperability and rapid deployment. A practical next step is to select one de-identified complex case and run a supervised multidisciplinary VR planning session, recording the decisions it changes.