3D Printing in Liver Surgery: A Systematic Review

Witowski, Jan; Coles‐Black, Jasamine; Zuzak, Tomasz; Pędziwiatr, Michał; Chuen, Jason; Major, Piotr; Budzyński, Andrzej

doi:10.1089/tmj.2017.0049

Cited by 66 publications

(74 citation statements)

References 20 publications

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“…Individuals creating the 3D liver model for pre-operative applications should attain a sound understanding of the software involved, as well as the anatomy and pathology of interest (20,29). Involvement of the reporting radiologist and surgeon (or surgeons) in 3D liver model production should also be considered to ensure accuracy of segmentation and identification of appropriate critical structures required for surgical planning (10,20).…”

Section: D Model Productionmentioning

confidence: 99%

“…Intraoperative measurements were acquired and compared to measurements taken from the corresponding liver model, which is regarded as the gold standard in the evaluation of 3D liver model accuracy (20). The models were deemed highly accurate, with mean dimensional errors of <1.3 mm for vascular structures, and <4.0 mm for the entire liver model (13).…”

Section: Model Accuracymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Currently, 3D printed models are being used as clinical tools in the endeavour to bridge this gap, enhancing the viewer's cognitive comprehension of anatomy and pathology in areas such as medical education, surgical training, surgical planning and operative simulation (2,3,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The tactile experience is known to support a holistic evaluation of important anatomical and/or pathological features (10), with the manipulation and visualization of the physical 3D printed models providing the in-depth understanding required to plan accurate, safe, and effective surgical procedures (4,5,13,14,16,(17)(18)(19)(20)(21).3D printed liver models have been found to enhance the viewer's understanding of highly variable and complex hepatic anatomy (13,14,16,18,22). There are a number of case studies that deem 3D printed liver models to be useful clinical tools in pre-and perioperative processes for the resection of liver lesions and in living donor liver transplant procedures (3,6,9,13,16,23).…”

mentioning

confidence: 99%

“…The importance of satisfying certain pre-requisites and implementing methods for quality control pertaining to software management and model production should be considered by future researchers. This may facilitate the acquisition of a patient-specific 3D printed liver model that is pathologically, anatomically, and structurally correct (20,29). …”

mentioning

confidence: 99%

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Patient-specific three-dimensional printing for pre-surgical planning in hepatocellular carcinoma treatment

Perica

Sun

2017

Quant. Imaging Med. Surg.

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Background: Recently, three-dimensional (3D) printing has shown great interest in medicine, and 3D printed models may be rendered as part of the pre-surgical planning process in order to better understand the complexities of an individual's anatomy. The aim of this study is to investigate the feasibility of utilising 3D printed liver models as clinical tools in pre-operative planning for resectable hepatocellular carcinoma (HCC) lesions.Methods: High-resolution contrast-enhanced computed tomography (CT) images were acquired and utilized to generate a patient-specific 3D printed liver model. Hepatic structures were segmented and edited to produce a printable model delineating intrahepatic anatomy and a resectable HCC lesion. Quantitative assessment of 3D model accuracy compared measurements of critical anatomical landmarks acquired from the original CT images, standard tessellation language (STL) files, and the 3D printed liver model.Comparative analysis of surveys completed by two radiologists investigated the clinical value of 3D printed liver models in radiology. The application of utilizing 3D printed liver models as tools in surgical planning for resectable HCC lesions was evaluated through kappa analysis of questionnaires completed by two abdominal surgeons.Results: A scaled down multi-material 3D liver model delineating patient-specific hepatic anatomy and pathology was produced, requiring a total production time of 25.25 hours and costing a total of AUD $1,250.A discrepancy was found in the total mean of measurements at each stage of production, with a total mean of 18.28±9.31 mm for measurements acquired from the original CT data, 15.63±8.06 mm for the STL files, and 14.47±7.71 mm for the 3D printed liver model. The 3D liver model did not enhance the radiologists' perception of patient-specific anatomy or pathology. Kappa analysis of the surgeon's responses to survey questions yielded a percentage agreement of 80%, and a κ value of 0.38 (P=0.24) indicating fair agreement.Conclusions: Study outcomes indicate that there is minimal value in utilizing the 3D printed models in diagnostic radiology. The potential usefulness of utilizing patient-specific 3D printed liver models as tools in surgical planning and intraoperative guidance for HCC treatment is verified. However, the feasibility of this application is currently challenged by identified limitations in 3D model production, including the cost and time required for model production, and inaccuracies potentially introduced at each stage of model fabrication. IntroductionLiver lesion resection is often a complex task requiring sound comprehension of patient specific anatomical and pathological characteristics to ensure optimal surgical outcomes (1-6). Diagnostic imaging plays a major role in the diagnosis and characterisation of liver lesions, with imaging appearance and radiological reporting outcomes being utilized to direct patient-specific treatment planning (7,8). However, confidence in the comprehension of anatomical, pathological and structural com...

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Section: D Model Productionmentioning

confidence: 99%

Section: Model Accuracymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Patient-specific three-dimensional printing for pre-surgical planning in hepatocellular carcinoma treatment

Perica

Sun

2017

Quant. Imaging Med. Surg.

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Advanced Biomaterials and Processing Methods for Liver Regeneration: State‐of‐the‐Art and Future Trends

Morais

Vieira

Zhao

et al. 2020

Adv Healthcare Materials

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Liver diseases contribute markedly to the global burden of mortality and disease. The limited organ disposal for orthotopic liver transplantation results in a continuing need for alternative strategies. Over the past years, important progress has been made in the field of tissue engineering (TE). Many of the early trials to improve the development of an engineered tissue construct are based on seeding cells onto biomaterial scaffolds. Nowadays, several TE approaches have been developed and are applied to one vital organ: the liver. Essential elements must be considered in liver TE—cells and culturing systems, bioactive agents or growth factors (GF), and biomaterials and processing methods. The potential of hepatocytes, mesenchymal stem cells, and others as cell sources is demonstrated. They need engineered biomaterial‐based scaffolds with perfect biocompatibility and bioactivity to support cell proliferation and hepatic differentiation as well as allowing extracellular matrix deposition and vascularization. Moreover, they require a microenvironment provided using conventional or advanced processing technologies in order to supply oxygen, nutrients, and GF. Herein the biomaterials and the conventional and advanced processing technologies, including cell‐sheets process, 3D bioprinting, and microfluidic systems, as well as the future trends in these major fields are discussed.

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Dual‐extrusion 3D printing of anatomical models for education

Smith

Jones

2017

Anatomical Sciences Ed

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Two material 3D printing is becoming increasingly popular, inexpensive and accessible. In this paper, freely available printable files and dual extrusion fused deposition modelling were combined to create a number of functional anatomical models. To represent muscle and bone FilaFlex flexible filament and polylactic acid (PLA) filament were extruded respectively via a single 0.4 mm nozzle using a Big Builder printer. For each filament, cubes (5 mm ) were printed and analyzed for X, Y, and Z accuracy. The PLA printed cubes resulted in errors averaging just 1.2% across all directions but for FilaFlex printed cubes the errors were statistically significantly greater (average of 3.2%). As an exemplar, a focus was placed on the muscles, bones and cartilage of upper airway and neck. The resulting single prints combined flexible and hard structures. A single print model of the vocal cords was constructed which permitted movement of the arytenoids on the cricoid cartilage and served to illustrate the action of intrinsic laryngeal muscles. As University libraries become increasingly engaged in offering inexpensive 3D printing services it may soon become common place for both student and educator to access websites, download free models or 3D body parts and only pay the costs of print consumables. Novel models can be manufactured as dissectible, functional multi-layered units and offer rich possibilities for sectional and/or reduced anatomy. This approach can liberate the anatomist from constraints of inflexible hard models or plastinated specimens and engage in the design of class specific models of the future. Anat Sci Educ 11: 65-72. © 2017 American Association of Anatomists.

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3D Printing in Liver Surgery: A Systematic Review

Cited by 66 publications

References 20 publications

Patient-specific three-dimensional printing for pre-surgical planning in hepatocellular carcinoma treatment

Patient-specific three-dimensional printing for pre-surgical planning in hepatocellular carcinoma treatment

Advanced Biomaterials and Processing Methods for Liver Regeneration: State‐of‐the‐Art and Future Trends

Dual‐extrusion 3D printing of anatomical models for education

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