There'll probably never be another patient like Larry Smarr, PhD, an astrophysicist turned computer scientist who created a life-sized 3D-printed model of his inflamed sigmoid colon and then made a virtual reality PowerPoint presentation of his disease process for his surgeon.

"Come over to my Cave and look at my colon," is how Dr. Smarr worded his invitation to colon and rectal surgeon Sonia Ramamoorthy, MD, FACS, FASCRS, to join him in the virtual reality "Cave" at the California Institute for Telecommunications and Information Technology in La Jolla, Calif., an academic research institution where he serves as founding director.

Dr. Ramamoorthy could hardly believe her eyes when she entered the darkened room. Projected onto a black wall was a 6-foot high 3D image of Dr. Smarr's intestine. She'd never been able to visualize an internal organ as a 3D reconstruction. Doing so changed how she thought about how she'd perform the sigmoid colon resection surgery. Before the first incision, she saw precisely where to resect and she saw the small kink that would add a degree of complexity to the procedure. For a surgeon used to operating based on a 2D image of a patient's MRI or CT scan, Dr. Ramamoorthy saw the future of surgery, one in which surgeons could look up at a virtual reality model on a monitor and down at the flesh-and-blood organ on the table.

"It was unbelievable to see the shape of the organ and how it was oriented in his body," says Dr. Ramamoorthy, chief of the division of colon and rectal surgery at University of California, San Diego Health.

"Visualizing it from various angles gave me the information I needed to start thinking about ways to approach the challenging case long before I entered the OR."

Pre-planning surgery with virtual reality models isn't the only imaging upgrade that promises to improve how your surgeons view surgery.

• Higher resolution. ORs are adding ultra high-definition 4K video just as Japanese researchers are developing an 8K laparoscope, which provides 16 times the resolution of standard HD. 8K will provide images of anatomy that are sharper, clearer and life-like in color. Surgeons working with 8K scopes will also be able to zoom way in on structures and tissue without losing an ounce of clarity.

"Improved resolution enhances surgeons' views and lets them see important structures with deeper clarity," says Dr. Ramamoorthy. "In general surgery, we operate around very small nerves, which, if nicked, could harm a patient's sexual performance or bladder function. To see those nerves in greater detail could improve outcomes and quality of life."

• Image enhancement. During Dr. Smarr's surgery, Dr. Ramamoorthy used green-contrast imaging and fluorescein dye to visualize blood flow in the tips of the resected colon to determine where it would be best to reattach the ends. Some imaging systems also have integrated platforms that automatically brighten dark areas of video images and heighten color contrasts and the natural color of anatomy, so surgeons can more easily identify nerves, blood vessels and tissue.

"Many surgeons believe they can differentiate structures and tell how well tissue is perfused with the naked eye," she says, "but there are subtleties that image enhancement and lighting up the tissue [with dye] can identify."

• Big-screen surgery. Video monitors are stretching beyond 55 inches and feature tiling displays that let you show several images at once, including CT scans, live laparoscopic views of surgery and vital signs readings.

During Dr. Smarr's robotic procedure, the OR team was fascinated with the live video feed that was routed to a large wall-mounted monitor. The 3D model of the colon displayed next to the laparoscopic camera feed gave them situational awareness that they can't get by watching surgeons manipulate instruments on a standard-sized screen.

"I love the big monitors," says Dr. Ramamoorthy, who finds that her surgical team and anesthesia providers are much more engaged during procedure because they can follow the action more closely and in greater detail.

CT scans captured before and during surgery can be integrated on big screens to let surgeons work with real-time views of anatomy, even as structures shift due to patient positioning or surgical manipulation. Dr. Ramamoorthy, for example, requested that her team tilt the 3D rendering of Dr. Smarr's colon on the big screen so that it matched the angle she saw through the robotic control console.

"One of the challenges moving forward will be how to deal with the potential of information overload," says Dr. Ramamoorthy. While operating on Dr. Smarr, she glanced up at the wall-mounted big screen and took a second to zero in on what she needed to see.

"Surgeons now have access to a lot of visual information," she says. "They need to triage that information, digest it and decide what is most important in order to make the best possible decisions. That might require computer-aided, artificially intelligent guidance in the future." OSM