Value of 3D printing for the comprehension of surgical anatomy

BackgroundIn a preliminary experience, we claimed the potential value of 3D printing technology for pre-operative counseling and surgical planning. However, no objective analysis has ever assessed its additional benefit in transferring anatomical information from radiology to final users. We decided to validate the pre-operative use of 3D-printed anatomical models in patients with solid organs’ diseases as a new tool to deliver morphological information.MethodsFifteen patients scheduled for laparoscopic splenectomy, nephrectomy, or pancreatectomy were selected and, for each, a full-size 3D virtual anatomical object was reconstructed from a contrast-enhanced MDCT (Multiple Detector Computed Tomography) and then prototyped using a 3D printer. After having carefully evaluated—in a random sequence—conventional contrast MDCT scans, virtual 3D reconstructions on a flat monitor, and 3D-printed models of the same anatomy for each selected case, thirty subjects with different expertise in radiological imaging (10 medical students, 10 surgeons and 10 radiologists) were administered a multiple-item questionnaire. Crucial issues for the anatomical understanding and the pre-operative planning of the scheduled procedure were addressed.ResultsThe visual and tactile inspection of 3D models allowed the best anatomical understanding, with faster and clearer comprehension of the surgical anatomy. As expected, less experienced medical students perceived the highest benefit (53.9% ± 4.14 of correct answers with 3D-printed models, compared to 53.4 % ± 4.6 with virtual models and 45.5% ± 4.6 with MDCT), followed by surgeons and radiologists. The average time spent by participants in 3D model assessing was shorter (60.67 ± 25.5 s) than the one of the corresponding virtual 3D reconstruction (70.8 ± 28.18 s) or conventional MDCT scan (127.04 ± 35.91 s).Conclusions3D-printed models help to transfer complex anatomical information to clinicians, resulting useful in the pre-operative planning, for intra-operative navigation and for surgical training purposes.

[1]  Isabelle Borget,et al.  Advantages and disadvantages of 3-dimensional printing in surgery: A systematic review. , 2016, Surgery.

[2]  Cristiano Quintini,et al.  Three‐dimensional print of a liver for preoperative planning in living donor liver transplantation , 2013, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[3]  Nigel W John,et al.  Interrogation of patient data delivered to the operating theatre during hepato-pancreatic surgery using high-performance computing , 2004, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[4]  Stephen D Laycock,et al.  3-D printout of a DICOM file to aid surgical planning in a 6 year old patient with a large scapular osteochondroma complicating congenital diaphyseal aclasia. , 2012, Journal of radiology case reports.

[5]  Rajagopalan Raman,et al.  Injecting realism in surgical training-initial simulation experience with custom 3D models. , 2014, Journal of surgical education.

[6]  Volkmar Falk,et al.  3D-Imaging of cardiac structures using 3D heart models for planning in heart surgery: a preliminary study. , 2008, Interactive cardiovascular and thoracic surgery.

[7]  Frank Meijer,et al.  Active exploration improves perceptual sensitivity for virtual 3D objects in visual recognition tasks , 2011, Vision Research.

[8]  Tipu Aziz,et al.  Utility of multimaterial 3D printers in creating models with pathological entities to enhance the training experience of neurosurgeons. , 2014, Journal of neurosurgery.

[9]  O. Reichelt,et al.  Preoperative simulation of partial nephrectomy with three‐dimensional computed tomography , 2000, BJU international.

[10]  Astrid M L Kappers,et al.  Human perception of shape from touch , 2011, Philosophical Transactions of the Royal Society B: Biological Sciences.

[11]  Frederik L. Giesel,et al.  3D printing based on imaging data: review of medical applications , 2010, International Journal of Computer Assisted Radiology and Surgery.

[12]  Justin W. Adams,et al.  The production of anatomical teaching resources using three‐dimensional (3D) printing technology , 2014, Anatomical sciences education.

[13]  Tadashi Kondo,et al.  Preoperative 3D volumetric analysis for liver congestion applied in a patient with hilar cholangiocarcinoma , 2010, Langenbeck's Archives of Surgery.

[14]  Guido Gerig,et al.  User-guided 3D active contour segmentation of anatomical structures: Significantly improved efficiency and reliability , 2006, NeuroImage.

[15]  Ian Gibson,et al.  Additive manufacturing technologies : 3D printing, rapid prototyping, and direct digital manufacturing , 2015 .

[16]  Ferdinando Auricchio,et al.  From CT scanning to 3-D printing technology for the preoperative planning in laparoscopic splenectomy , 2015, Surgical Endoscopy.

[17]  H. H. Malik,et al.  Three-dimensional printing in surgery: a review of current surgical applications. , 2015, The Journal of surgical research.

[18]  Ahmad B. AlAli,et al.  Three-Dimensional Printing Surgical Applications , 2015, Eplasty.

[19]  E. Fishman,et al.  Three-dimensional volume rendering of spiral CT data: theory and method. , 1999, Radiographics : a review publication of the Radiological Society of North America, Inc.

[20]  H. Bülthoff,et al.  Estimation of 3D shape from image orientations , 2011, Proceedings of the National Academy of Sciences.

[21]  Raju Thomas,et al.  Physical models of renal malignancies using standard cross-sectional imaging and 3-dimensional printers: a pilot study. , 2014, Urology.