Cost-effective, personalized, 3D-printed liver model for preoperative planning before laparoscopic liver hemihepatectomy for colorectal cancer metastases

Abstract

PurposeThree-dimensional (3D) printing for preoperative planning has been intensively developed in the recent years. However, the implementation of these solutions in hospitals is still difficult due to high costs, extremely expensive industrial-grade printers, and software that is difficult to obtain and learn along with a lack of a defined process. This paper presents a cost-effective technique of preparing 3D-printed liver models that preserves the shape and all of the structures, including the vessels and the tumor, which in the present case is colorectal liver metastasis.MethodsThe patient’s computed tomography scans were used for the separation and visualization of virtual 3D anatomical structures. Those elements were transformed into stereolithographic files and subsequently printed on a desktop 3D printer. The multipart structure was assembled and filled with silicone. The patient underwent subsequent laparoscopic right hemihepatectomy. The entire process is described step-by-step, and only free-to-use and mostly open-source software was used.ResultsAs a result, a transparent, full-sized liver model with visible vessels and colorectal metastasis was created for under $150, which—taking into account 3D printer prices—is much cheaper than models presented in previous research papers.ConclusionsThe increased accessibility of 3D models for physicians before complex laparoscopic surgical procedures such as hepatic resections could lead to beneficial breakthroughs in these sophisticated surgeries, as many reports show that these models reduce operative time and improve short term outcomes.

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

“…Image visualization and processing tools within this software were used to (I) apply a median filter, reducing image noise and enhancing the anatomical boundaries for accurate segmentation; (II) segment structures of interest; and (III) export the segmented data in standard tessellation language (STL) file format as required for editing and 3D printing (10,16,18,(22)(23)(24)(25). Anatomical structures that were perceived likely to affect decisions made in surgical planning included the inferior vena cava, portal vein and associated branches, hepatic veins, hepatic artery, the tumour and associated arterial supply, and the liver body (2,3,9,23).…”

“…The cost and time required for 3D liver model production remains to be a major limitation (4,9,13,18). In aim of reducing print time and cost, the liver model was printed at 60% of its true size.…”

“…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).…”

“…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).…”