LiverPlan: A Stage-Adaptive Immersive Visual Analytics Framework for Anatomical Liver Surgical Planning

Abstract

Anatomical liver resection (ALR) surgery is the most important treatment for liver cancer, yet preoperative planning demands complex, multi-stage clinical reasoning under competing safety constraints. Current 2D desktop tools are not well equipped to support this process, exhibiting three fundamental limitations: reliance on monolithic interfaces that fail to adapt to the distinct cognitive demands of each planning stage; a perceptual bottleneck caused by limited anatomical spatial representation and missing plane-vessel intersection visualization; and an attention bottleneck stemming from fragmented critical safety criteria display across separate views. We present LiverPlan, a stage-adaptive immersive visual analytics framework for ALR planning, grounded in an 8-month collaboration with two expert hepatobiliary surgeons. Decomposing the surgical planning process into three sequential yet cognitively distinct stages, LiverPlan externalizes the cognitive demand of each stage via tailored techniques: (1) context-preserving focus and hue-preserving rendering for anatomical discovery; (2) direct 3D resection plane manipulation coupled with real-time, embedded visual feedback on critical safety criteria during plan refinement; and (3) explicit plane-vessel intersection visualization for anticipatory surgery preparation. A within-subjects study with eight hepatobiliary surgeons against a desktop baseline shows large-effect-size improvements in task completion time, perceived cognitive workload, and system usability on controlled planning tasks. Moreover, our study reveals broader insights: LiverPlan reduces cognitive burden and encourages a shift in surgeons from merely satisfying safety criteria to actively optimizing them, suggesting that explicit visualization of spatial relationships lowers the cognitive barrier to complex surgical planning.

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