SRS166 - Comparison of virtual reality and 2D imaging in neuroblastoma surgical planning

Abstract Background Radical neuroblastoma resection is complex, requiring detailed knowledge of tumour–organ–vessel anatomy. Planning traditionally relies on Image-Defined Risk Factors (IDRFs) from CT/MRI. Virtual reality (VR) provides immersive 3D reconstructions with depth perception and interactive features, improving anatomical visualisation. This study evaluates whether VR provides advantages over conventional 2D imaging for preoperative planning and training in abdominal neuroblastoma. Methods CT scans of nine high-risk neuroblastoma patients treated at GOSH were segmented in Materialise Mimics 24.0 to generate VR 3D models. Paediatric surgical trainees and consultants assessed each case using CT and VR, scoring vascular/organ involvement, evaluating resection feasibility, and rating confidence and anatomical understanding. Data were analysed using Wilcoxon and Mann–Whitney tests. Results VR significantly improved anatomical assessment over CT (P < 0.001). Accuracy increased with expertise: consultants improved 7% (P < 0.05) and senior registrars 12.5% (P < 0.01). VR enhanced interpretation of IDRFs (P < 0.01), vessels (P < 0.05), and organs (P < 0.05), reducing expertise-related performance gaps. The use of VR prompted a change in the preoperative plan in 78.1% of cases. In assessments of confidence and anatomical understanding, VR consistently outperformed CT in key areas such as anatomical interpretation, surgical strategy planning, and perception of case complexity. Feedback showed 67% valued VR for patient communication. Two-thirds reported improved decision-making, one-third noted anatomical detail limitations, and 83% emphasised its intuitive, low-training interface. Conclusions VR outperformed CT in anatomical interpretation, surgical planning, and perceived case complexity. While currently complementary to standard imaging, it holds potential to become central in surgical planning and training for neuroblastoma.