3D printing to simulate laparoscopic choledochal surgery

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 trainer dimensions were employed to create an entry level laparoscopic choledochal surgery model. The information was fed into a 3D systems project 660pro with visijet pxl core powder to create a free standing liver mould. This included a cuboid portal in which to slot disposable hybrid components representing hepatic and pancreatic ducts and choledochal cyst. The mould was used to create soft silicone replicas with T28 resin and T5 fast catalyst. The model was assessed at a national pediatric surgery training day. Results:The 10 delegates that trialed the simulation felt that the tactile likeness was good (5.6/10 +/-1.71, 10=like the real thing), was not too complex (6.2/10 +/-1.35; where 1=too simple, 10=too complicated), and generally very useful (7.36/10 +/-1.57, 10=invaluable). 100% stated that they felt they could reproduce this in their own centres, and 100% would recommend this simulation to colleagues. Conclusion:Though this first phase choledochal cyst excision simulation requires further development, 3D printing provides a useful means of creating specific and detailed simulations for rare and complex operations with huge potential for development.

Surgical applications of three-dimensional printing: a review of the current literature & how to get started

“…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).…”

Role of innovative 3D printing models in the management of hepatobiliary malignancies

“…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].…”

A Prototype Educational Model for Hepatobiliary Interventions: Unveiling the Role of Graphic Designers in Medical 3D Printing

“…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.…”