Pediatric cardiac surgeons frequently encounter significant visibility challenges during Right Vertical Infra-Axillary Thoracotomy (RVIAT). Consequently, the complexity of a "crowded thorax" in small children makes choosing the correct incision site critical for a successful outcome. To solve this problem, medical researchers developed a patient-specific RVIAT preoperative planner. This web-based application uses computed tomography (CT) data to simulate and optimize surgical trajectories before the patient enters the operating room.

Specifically, the framework employs advanced ray-casting algorithms. These algorithms generate a quantitative "Visibility Score" for various intracardiac targets and cannulation sites. Therefore, surgeons can objectively evaluate which intercostal space (ICS) offers the clearest view. During a validation study, this tool compared the standard 4th ICS with the 3rd ICS. The results showed that the 3rd ICS significantly improved the visibility of secondary targets like Patent Ductus Arteriosus (PDA).

Improving Precision with the RVIAT Preoperative Planner

Furthermore, the RVIAT preoperative planner offers real-time processing on the client side. This feature makes it a versatile, platform-independent tool for modern hospitals. In one dual-pathology case involving a Ventricular Septal Defect (VSD) and a PDA, the simulation increased PDA visibility from 72% to 86%. This improvement occurred without any loss of primary VSD exposure. Thus, the system provides a deterministic method to balance the needs of both intracardiac repair and obligatory cannulation.

Additionally, sensitivity analyses confirmed the robustness of this system across different anatomical conditions. While chest wall thickness and instrument constraints impact some exposure, deep intracardiac targets generally maintain high visibility scores. Consequently, this technology reduces the trial-and-error nature of incision selection. It ensures that pediatric patients receive the safest and most effective surgical care possible.

Frequently Asked Questions

How does the RVIAT preoperative planner improve surgical safety?

The planner uses patient-specific CT data to simulate the surgical field. By calculating a numerical visibility score, surgeons can avoid trial-and-error and choose the intercostal space that provides the best access to both the heart defect and the cannulation sites.

Can this tool be used on any computer?

Yes, the system is a web-based, platform-independent application. Because it performs real-time processing on the client side, it is easily accessible to surgical teams without requiring specialized hardware.

Disclaimer: This content is for informational and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Hu SY et al. Development of a web-based preoperative planner for right vertical infra-axillary thoracotomy. Comput Assist Surg (Abingdon). 2026 Dec undefined. doi: 10.1080/24699322.2026.2635776. PMID: 41793778.

Liang W, et al. Modified Right Vertical Infra-Axillary Thoracotomy: 2-5cm Incision Approach to Repair Various Congenital Heart Diseases in All Age Groups. ePostersOnline. 2024.

Luo H, et al. Right vertical infra-axillary thoracotomy for surgical repair of pediatric ventricular septal defect: A propensity score matched cohort study. Interdiscip Cardiovasc Thorac Surg. 2025;40(8):ivaf153.