The meta-analysis showed that LLR is beneficial in terms of overall morbidity and non-procedure-specific complications. That being said, these results are based on non-randomized trials. For these reasons, we are calling for randomization in upcoming studies. Systematic review registration: PROSPERO registration number CRD42018084576.

PurposeAlthough high costs are often cited as the main limitation of 3D printing (3DP) in the medical field, current lack of clinical evidence is asserting itself as an impost as the field begins to mature. The aim is to review clinical trials in the field of 3DP, an area of research which has grown dramatically in recent years.MethodsWe surveyed clinical trials registered in 15 primary registries worldwide, including ClinicalTrials.gov. All trials which utilized 3DP in a clinical setting were included in this review. Our search was performed on December 15, 2017. Data regarding the purpose of the study, inclusion criteria, number of patients enrolled, primary outcomes, centers, start and estimated completion dates were extracted.ResultsA total of 92 clinical trials with 252 patients matched the criteria and were included in the study. A total of 42 (45.65%) studies cited China as their location. Only 10 trials were multicenter and 2 were registered as international. The discipline that most commonly utilized 3DP was Orthopedic Surgery, with 25 (27.17%) registered trials. At the time of data extraction, 17 (18.48%) clinical trials were complete.ConclusionsAfter several years of case reports, feasibility studies and technical reports in the field, larger-scale studies are beginning to emerge. There are almost no international register entries. Although there are new emerging areas of study in disciplines that may benefit from 3DP, it is likely to remain limited to very specific applications.Electronic supplementary materialThe online version of this article (10.1007/s11548-018-1793-8) contains supplementary material, which is available to authorized users.

IntroductionLeft atrial appendage occlusion procedure (LAAO) became an alternative method for stroke prevention in atrial fibrillation (AF) patients with contraindication or intolerance for oral anticoagulation therapy. However, LAA anatomy is complex with several different types of LAA morphology. Therefore matching the correct size of a delivery device to LAA morphology is difficult. In such circumstances, the 3D-printed model of LAA closure may be useful for preoperative planning which increases the efficacy of LAAO procedure.Material and methodsWe report as a first 2 cases of LAA occlusion procedure using 2 different systems: thoracoscopic AtriClip and the LARIAT device in which a 3D printed LAA model was used in preoperative planning.ResultsIn the first patient, preoperative measurements of 3D LAA model were performed using a dedicated selection guide for AtriClip device were comparable with the intraoperative examination. Left atrial appendage was closed epicardial using 40 mm size AtriClip. In second patients, LAA closure was performed completely percutaneously using LARIAT device. For better visualization of LAA shape on fluoroscopy and TEE examination, intraoperatively sterilized 3D LAA model was used during the procedure. In both cases, intraoperative TEE examination confirmed complete LAA closure with no leak.ConclusionsLeft atrial appendage 3D model is a useful tool in preoperative planning of a left atrial appendage occlusion using epicardial approaches with thoracoscopic or percutaneous access using LARIAT device. The quality of low-cost 3D printed LAA model is sufficient in planning minimally invasive procedure.

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Evaluation of the frequency and severity of postoperative complications is an integral part of establishing the clinical utility of a specific treatment. They define the possible consequences resulting from the chosen method of treatment, and thus the potential risks associated with this choice. Thanks to the analysis of complications, it is possible to evaluate patients' safety, identify a problem in the course of surgery within a given hospital and surgical team or carry a financial analysis. Not only is the frequency of occurrence important, but so is the severity of complications. Therefore, in recent years we have seen the development of several new tools for assessing postoperative complications such as the Clavien-Dindo scale, the Accordion Severity Grading System, the Postoperative Morbidity Index or the Comprehensive Complication Index. Analysis of the above-mentioned scales may contribute to the development of clear algorithms for the management of older patients at increased risk of severe complications and higher mortality, which subsequently may lead to increased efficacy and safer treatment in this population.

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Background: There remains much variance and controversy in the treatment and clinical management of benign liver tumors. The indications for surgical intervention for these such tumors include symptom management, risk of complications, and suspicion of malignancy. The aim of this study is to analyze the indications and outcomes after resection of benign solid liver lesions from patients treated at a large comprehensive cancer institution. Methods: 93 patients received liver resection for benign solid liver tumors at MD Anderson Cancer Center from 1998 to 2017. The patient records were reviewed retrospectively, including demographic, peri-operative, and outcome parameters. Results: The study group includes 75 females and 18 males with the average age of 45 years old. 37 patients with hemangiomas (39.8%), 28 patients with hepatocellular adenomas (30.1%), 17 patients with focal nodular hyperplasia (18.3%), 7 patients (8.6%) with other solid tumors (angiomyolipoma, hemangioendothelioma, pecoma, etc). Symptom management and risk of complications were the most common preoperative indication in our series. 38 patients underwent a major hepatectomy (40.8%). The post-operative mortality rate was zero, but the post-operative complication rate was 21.5% and the peri-operative blood transfusion rate was 16.1%. The median follow-up of 19 months, 92 patients (99%) were alive and two patients (2.2%) developed malignancy degeneration. Outcomes: Although liver resection can be performed safely in well-selected patients without mortality, there still remains a risk of complication. Surgical intervention should be carefully evaluated on an individualized basis utilizing an evidence-based treatment algorithm.

Objective: We investigated the knowledge about atrial fibrillation (AF) and oral anticoagulants (OACs) in AF patients scheduled for cardiac surgery compared with nonsurgical AF patients. Methods: We recruited 144 consecutive patients with documented AF scheduled for cardiac surgery on admission (aged 68.9±8.4, male 60.4 %). The control group represented 200 age- and sex-matched AF patients without indications for surgery. Using the validated Jessa AF Knowledge Questionnaire (JAKQ), we tested their knowledge of AF and the use of OAC. Results: The mean score on the JAKQ was 47±20 % in the surgery group and 59±18 % in the control group (p<0.001), without any questions in which the former group scored better. A higher level of knowledge was observed in patients taking vitamin K antagonists (VKA) in the past, and individuals free of heart failure, previous stroke, or peripheral artery disease. Patients had poor knowledge of the safety issues, including 27.5% of surgical patients who knew about possible painkillers use during anticoagulation compared with 43.8% in the control group (p=0.002). Patients scheduled for valvular surgery (n=88, 61.5%) scored better compared with those (n=26, 18.2%) for coronary artery bypass graft (CABG) surgery (49±19% vs. 35±18 %, p=0.002 respectively). Conclusion: The level of knowledge about AF and its treatment, including the safety issues, is poor among AF patients admitted for cardiac surgery. More educational efforts should be taken in this vulnerable patient subset.