Three-dimensional print of a liver for preoperative planning in living donor liver transplantation

Abstract

The growing demand for liver transplantation and the concomitant scarcity of cadaveric livers have increased the need for living donor liver transplantation (LDLT). Ensuring the safety of donors and recipients is critical. The preoperative identification of the vascular and biliary tract anatomy with 3-dimensional (3D) printing may allow better preoperative surgical planning, avert unnecessary surgery in patients with potentially unsuitable anatomy, and thereby decrease the complications of liver transplant surgery. We developed a protocol and successfully 3D-printed synthetic livers (along with their complex networks of vascular and biliary structures) replicating the native livers of 6 patients: 3 living donors and 3 respective recipients who underwent LDLT. To our knowledge, these are the first complete 3D-printed livers. Using standardized preoperative, intraoperative, and postoperative assessments, we demonstrated identical anatomical and geometrical landmarks in the 3D-printed models and native livers. Three-dimensional (3D) printing is a process for making a solid 3D object of virtually any shape from a digital model. A 3D printer works as an ordinary office printer, but instead of placing a single layer of ink on paper, the machine lays down successive thin layers of a material to form a 3D object that replicates the original one. 1 The growing demand for liver transplantation and the concomitant shortage of cadaveric livers have led to a rise in living donor liver transplantation (LDLT), in which resection of the right or left liver lobe is performed for the purpose of liver transplantation. 2 Living donors are healthy individuals, so ensuring their safety is of paramount importance. There have been a number of reported donor deaths worldwide and a substantial number of donor morbidities, so there is a need for measures to optimize donor safety. 3 Many of these morbidities are attributable to incomplete preoperative anatomical characterization of vascular and biliary structures and inaccurate estimates of the liver volume; these data are needed to determine the extent of the resection. This information provides a road map, and its accuracy has improved with the introduction of radiological software able to provide 3D visualization of liver structures. 4,5 3D imaging has the ability to better demonstrate the 3D relationships between vital vascular and biliary structures and the surrounding parenchyma in comparison with conventional computed tomography (CT) or magnetic resonance imaging (MRI). 3D imaging Additional Supporting Information may be found in the online version of this article.

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

“…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).…”

“…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).…”

Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis

“…Until now, the technology has been used widely in the diagnosis of liver disease and planning of liver surgery [13][14][15] . For the latter, the strategy involves: surgical assessment of benign/ malignant liver tumors; assessment of the safety of living-donor liver transplantation; and evaluation of the anatomical complexity of hepatolithiasis [16][17][18][19] . We used 3D reconstruction technology for the preoperative assessment of HAE, and compared it with evaluation using conventional 2D imaging.…”

A Three-Dimensional Mediastinal Model Created with Rapid Prototyping in a Patient with Ectopic Thymoma

“…Three-dimensional (3D) models that are created using the rapid prototyping technique have been adopted in some fields of surgery, [1][2][3][4] and in general thoracic surgery, only a few pulmonary models have been reported. [5][6][7] To the best of our knowledge, there have been no reports of mediastinal models that were created with rapid prototyping technique.…”