Abstract:Aims of the Study:Laparoscopic simulation has transformed skills acquisition for many procedures. However, realistic non-biological simulators for complex reconstructive surgery are rare. Life-like tactile feedback is particularly difficult to reproduce. Technological innovations may contribute novel solutions to these shortages. We describe a hybrid model, harnessing 3D technology to simulate laparoscopic choledochal surgery for the first time.
Methods:Digital hepatic anatomy images and standard laparoscopic … Show more
“…In addition to using 3D printed anatomic models to simply gain a more accurate perception of the patient's anatomy, these models have also been used to perform mock surgeries pre-operatively with patient-specific anatomy. This can be highly valuable in the planning of surgery in a patient with highly complex or rare surgical pathology (64).…”
“…In pediatric surgery, published examples of pre-surgical patient specific simulations include laparoscopic choledocal cyst excision (64) and thoracoscopic infant lobectomy (71). These authors found pre-surgical simulation to be a valuable tool.…”
“…These authors found pre-surgical simulation to be a valuable tool. These anatomic models were also used in teaching residents, who found the simulations valuable for clinical practice and as a learning tool (64).…”
Three dimensional (3D) printing involves a number of additive manufacturing techniques that are used to build structures from the ground up. This technology has been adapted to a wide range of surgical applications at an impressive rate. It has been used to print patient-specific anatomic models, implants, prosthetics, external fixators, splints, surgical instrumentation, and surgical cutting guides. The profound utility of this technology in surgery explains the exponential growth. It is important to learn how 3D printing has been used in surgery and how to potentially apply this technology. PubMed was searched for studies that addressed the clinical application of 3D printing in all surgical fields, yielding 442 results. Data was manually extracted from the 168 included studies. We found an exponential increase in studies addressing surgical applications for 3D printing since 2011, with the largest growth in craniofacial, oromaxillofacial, and cardiothoracic specialties. The pertinent considerations for getting started with 3D printing were identified and are discussed, including, software, printing techniques, printing materials, sterilization of printing materials, and cost and time requirements. Also, the diverse and increasing applications of 3D printing were recorded and are discussed. There is large array of potential applications for 3D printing. Decreasing cost and increasing ease of use are making this technology more available. Incorporating 3D printing into a surgical practice can be a rewarding process that yields impressive results.
“…In addition to using 3D printed anatomic models to simply gain a more accurate perception of the patient's anatomy, these models have also been used to perform mock surgeries pre-operatively with patient-specific anatomy. This can be highly valuable in the planning of surgery in a patient with highly complex or rare surgical pathology (64).…”
“…In pediatric surgery, published examples of pre-surgical patient specific simulations include laparoscopic choledocal cyst excision (64) and thoracoscopic infant lobectomy (71). These authors found pre-surgical simulation to be a valuable tool.…”
“…These authors found pre-surgical simulation to be a valuable tool. These anatomic models were also used in teaching residents, who found the simulations valuable for clinical practice and as a learning tool (64).…”
Three dimensional (3D) printing involves a number of additive manufacturing techniques that are used to build structures from the ground up. This technology has been adapted to a wide range of surgical applications at an impressive rate. It has been used to print patient-specific anatomic models, implants, prosthetics, external fixators, splints, surgical instrumentation, and surgical cutting guides. The profound utility of this technology in surgery explains the exponential growth. It is important to learn how 3D printing has been used in surgery and how to potentially apply this technology. PubMed was searched for studies that addressed the clinical application of 3D printing in all surgical fields, yielding 442 results. Data was manually extracted from the 168 included studies. We found an exponential increase in studies addressing surgical applications for 3D printing since 2011, with the largest growth in craniofacial, oromaxillofacial, and cardiothoracic specialties. The pertinent considerations for getting started with 3D printing were identified and are discussed, including, software, printing techniques, printing materials, sterilization of printing materials, and cost and time requirements. Also, the diverse and increasing applications of 3D printing were recorded and are discussed. There is large array of potential applications for 3D printing. Decreasing cost and increasing ease of use are making this technology more available. Incorporating 3D printing into a surgical practice can be a rewarding process that yields impressive results.
“…Fifteen of the 32 studies refer to the utilization of 3D printed organs, based on the patients’ CT and MRI imaging data, to establish a better understanding of the lesions and the surrounding structures pre-operatively[16,20-33]. Ten studies refer to the use of 3D printed objects for educational uses[28,32,34-41], while seven studies describe and evaluate the technical properties of 3D printed models[34-36,42-45]. Other uses of 3D printing techniques account for six of the included studies[32,46-50].…”
Section: Current Status and Challenges Of 3d Printing In Hepatic Surgerymentioning
Three-dimensional (3D) printing has recently emerged as a new technique in various liver-related surgical fields. There are currently only a few systematic reviews that summarize the evidence of its impact. In order to construct a systematic literature review of the applications and effects of 3D printing in liver surgery, we searched the PubMed, Embase and ScienceDirect databases for relevant titles, according to the PRISMA statement guidelines. We retrieved 162 titles, of which 32 met the inclusion criteria and are reported. The leading application of 3D printing in liver surgery is for preoperative planning. 3D printing techniques seem to be beneficial for preoperative planning and educational tools, despite their cost and time requirements, but this conclusion must be confirmed by additional randomized controlled trials.
“…3D-printed liver models have also been shown to be effective tools in teaching the anatomy of hepatic segments to medical students [8]. The fastest growing and most innovative use for liver phantoms is procedure simulations; thus far, phantom simulations have been reported for laparoscopic choledochal cyst excision surgery and hepatoblastoma resection in pediatric patients and endoscopic ultrasound-guided biliary drainage [9][10][11]. Despite the fact that 3D-printed models for procedure simulation are ideally suited for interventional radiology, there are currently no reports of a hepatobiliary phantom having been manufactured for this purpose or for specific use in this field.…”
In the context of medical three-dimensional (3D) printing, in addition to 3D reconstruction from cross-sectional imaging, graphic design plays a role in developing and/or enhancing 3D-printed models. A custom prototype modular 3D model of the liver was graphically designed depicting segmental anatomy of the parenchyma containing color-coded hepatic vasculature and biliary tree. Subsequently, 3D printing was performed using transparent resin for the surface of the liver and polyamide material to develop hollow internal structures that allow for passage of catheters and wires. A number of concepts were incorporated into the model. A representative mass with surrounding feeding arterial supply was embedded to demonstrate tumor embolization. A straight narrow hollow tract connecting the mass to the surface of the liver, displaying the path of a biopsy device's needle, and the concept of needle "throw" length was designed. A connection between the middle hepatic and right portal veins was created to demonstrate transjugular intrahepatic portosystemic shunt (TIPS) placement. A hollow amorphous structure representing an abscess was created to allow the demonstration of drainage catheter placement with the formation of pigtail tip. Percutaneous biliary drain and cholecystostomy tube placement were also represented. The skills of graphic designers may be utilized in creating highly customized 3D-printed models. A model was developed for the demonstration and simulation of multiple hepatobiliary interventions, for training purposes, patient counseling and consenting, and as a prototype for future development of a functioning interventional phantom.
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