Antenatal Three-Dimensional Printing for Ex Utero Intrapartum Treatment Procedures

Paredes, Jessica Garcia de; Gosnell, Jordan M.; Strug, Michael; Giuliani, Emma; Thakur, Mili; Romero, Vivian; Cordoba, Marcos

doi:10.1097/aog.0000000000004650

Cited by 6 publications

(6 citation statements)

References 12 publications

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“…Advancements in antenatal diagnostics have significantly increased the detection of fetal airway obstructive lesions [4,[6][7][8][9], resulting in a broadened scope of indications and modifications to the EXIT procedure [10][11][12][13]. Presently, the EXIT procedure should be considered in any prenatal diagnosis where difficulties or compromises in neonatal adaptation to postnatal life are anticipated [4,6,14,15].…”

Section: Introductionmentioning

confidence: 99%

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

Domínguez-Moreno,

Chimenea,

Viegas-González

et al. 2024

Surgical Techniques Development

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The Ex Utero Intrapartum Treatment (EXIT) procedure has long been an invaluable tool in managing complex fetal conditions requiring airway interventions during the transition from intrauterine to extrauterine life. This technical note offers an in-depth examination of the EXIT procedure, emphasizing the refinements and innovations introduced at our center. The technique focuses on meticulous preoperative assessment and uses distinctive techniques and anesthetic methodologies. A multidisciplinary team assembles to plan the EXIT procedure, emphasizing patient communication and risk discussion. Our technique involves atraumatic access to the uterine cavity, achieved through the application of a uterine progressive distractor developed for this purpose. Following the use of this distractor, vascular clamps and a stapling device (Premium Poly Cs-57 Autosuture®, Medtronic) are employed. Our anesthetic approach employs general anesthesia with epidural catheter placement. Maternal operation involves low transverse laparotomy and intraoperative ultrasonography-guided hysterotomy. Fetal exposure includes gentle extraction or external version, ensuring airway access. After securing fetal airway access, umbilical cord clamping and maternal abdominal closure conclude the procedure. By revisiting the core principles of EXIT and incorporating center-specific advancements, we enhance our understanding and technical expertise. To our knowledge, this is the first time a detailed description of the technique has been published.

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Section: Introductionmentioning

confidence: 99%

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

Domínguez-Moreno,

Chimenea,

Viegas-González

et al. 2024

Surgical Techniques Development

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“…Mackey et al used 3D printed uterine model for surgical planning of a cesarean delivery complicated by multiple myomas and actually showed the model accurately represented the number, size, and locations of uterine myomas, therefore improved surgical planning and optimize outcomes for patient [10]. Garcia de Paredes et al also reported two cases that highlight the utility of a 3D printing technique to aid in ex utero intrapartum treatment procedures during cesarean delivery [11]. Nevertheless, only one article addressed the importance of a customized pessary [12].…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional printing vaginal pessary to treat pelvic organ prolapse: A pilot study

TSENG¹,

Lin

Chang

et al. 2022

Preprint

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Objective Pelvic organ prolapse (POP) is a common gynecological condition and pessaries are offered as a first line management, however, each woman presents with unique anatomy and thus the effectiveness of commercially available pessaries may be limited by lack of customization. This study aims to apply three-dimensional (3D) printing technology in seeking resolution. Design, setting, population and methods This was a pilot study, 6 patients with mean age 68 years (57 to 74) were treated with Gellhorn pessary for symptomatic POP were enrolled in our study. We put the Gellhorn-type pessary into the vagina to restore the prolapsed parts and under transvaginal ultrasound (US) guided to evaluate the gap which Gellhorn pessary can’t cover. Ototoform (an impression silicone) was used to make a sphere-shape mode and have it hooked onto Gellhorn pessary (template). We collected template and then applied 3D printing to customize silicone vaginal pessary. Results All 6 patients were satisfied with the customized made pessaries. No patients complained of adverse effects, such as discomfort, expulsion of the pessary, urinary incontinence, difficulty in urination or bowel movement, and vaginal bleeding during the study. Conclusions Our study demonstrates that a tailor made pessary may offer better solution for women with POP. A customized pessary can be made with the help of transvaginal US and 3D printing technology. Any local clinic can use simple tools (i.e. transvaginal US and pessary) with assistance from a 3D printing center to create a well fit pessary. With our innovation, distant is not a boundary.

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“…Mackey et al 10 used a 3D-printed uterine model for surgical planning of a cesarean delivery complicated by multiple myomas and actually showed the model accurately represented the number, size, and locations of uterine myomas, hence improving surgical planning and optimizing outcomes for patients. Garcia de Paredes et al 11 also reported two cases that highlight the utility of a 3D printing technique to aid in ex utero intrapartum treatment procedures during cesarean delivery. Nevertheless, only one article addressed the importance of a customized pessary 12 .…”

mentioning

confidence: 99%

“…6 However, the technology has only just begun to branch into the fields of gynecology and obstetrics. [7][8][9][10][11][12] Stitely et al 7 conducted a proof-of-concept study using 3D printing to fabricate a tubing connector for dilation and evacuation in a surgical procedure. Sandrini et al 8 reported their experience in 3D printing of fetal models of congenital heart disease derived from microfocus computed tomography.…”

mentioning

confidence: 99%

“…Recently, as a novel technology, 3D (three-dimensional) printing has been widely adopted in various fields of medicine 6 . However, the technology has only just begun to branch into the fields of gynecology and obstetrics 7–12 . Stitely et al 7 conducted a proof-of-concept study using 3D printing to fabricate a tubing connector for dilation and evacuation in a surgical procedure.…”

mentioning

confidence: 99%

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Tailor-made three-dimensional printing vaginal pessary to treat pelvic organ prolapse: a pilot study

et al. 2023

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Objective This study aimed to apply three-dimensional (3D) printing technology to treat women with pelvic organ prolapse (POP) and to evaluate efficacy based on the improvement by quality of life (QOL) questionnaires. Methods This was a pilot study at a tertiary urogynecology unit in Taiwan. Between January 2021 and June 6, 2021, participants who opted for self-management using Gellhorn pessaries to treat symptomatic POP were enrolled. For each woman, the original Gellhorn pessary was placed into the vagina to restore the prolapsed tissues and under transvaginal ultrasound guided to evaluate the gap which the Gellhorn pessary cannot cover. Otoform (an impression silicone) was used to make a model and have it hooked onto Gellhorn pessary (template). We collected templates and then applied 3D printing to customize the silicone vaginal pessary. All women completed multiple validated QOL questionnaires at baseline and at 3 and 6 months. Results Six women completed the study. The QOL questionnaires revealed significant improvements across the board. Conclusions Our study demonstrates that a tailor made 3D pessary can be used for women with POP. A customized pessary can be made with the help of transvaginal ultrasound and 3D printing technology.

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Antenatal Three-Dimensional Printing for Ex Utero Intrapartum Treatment Procedures

Cited by 6 publications

References 12 publications

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

Three-dimensional printing vaginal pessary to treat pelvic organ prolapse: A pilot study

Tailor-made three-dimensional printing vaginal pessary to treat pelvic organ prolapse: a pilot study

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