Current and future role of three-dimensional modelling technology in rectal cancer surgery: A systematic review

Abstract

BACKGROUND Three-dimensional (3D) modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models, which more closely resemble the complex environment encountered during surgery. It has been successfully applied to surgical planning and navigation, as well as surgical training and patient education in several surgical specialties, but its uptake lags behind in colorectal surgery. Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis, which is difficult to comprehend and visualise. AIM To review the current and emerging applications of the 3D models, both virtual and physical, in rectal cancer surgery. METHODS Medline/PubMed, Embase and Scopus databases were searched using the keywords “rectal surgery”, “colorectal surgery”, “three-dimensional”, “3D”, “modelling”, “3D printing”, “surgical planning”, “surgical navigation”, “surgical education”, “patient education” to identify the eligible full-text studies published in English between 2001 and 2020. Reference list from each article was manually reviewed to identify additional relevant papers. The conference abstracts, animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded. Data were extracted from the retrieved manuscripts and summarised in a descriptive way. The manuscript was prepared and revised in accordance with PRISMA 2009 checklist. RESULTS Sixteen studies, including 9 feasibility studies, were included in the systematic review. The studies were classified into four categories: feasibility of the use of 3D modelling technology in rectal cancer surgery, preoperative planning and intraoperative navigation, surgical education and surgical device design. Thirteen studies used virtual models, one 3D printed model and 2 both types of models. The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer, was shown to be feasible. Within the clinical context, 3D models were used to identify vascular anomalies, for surgical planning and navigation in lateral pelvic wall lymph node dissection and in management of recurrent rectal cancer. Both physical and virtual 3D models were found to be valuable in surgical education, with a preference for 3D printed models. The main limitations of the current technology identified in the studies were related to the restrictions of the segmentation process and the lack of 3D printing materials that could mimic the soft and deformable tissues. CONCLUSION 3D modelling technology has potential to be utilised in multiple aspects of rectal cancer surgery, however, it is still at the experimental stage of application in this setting.

A Meta-Review about Medical 3D Printing

“…Non-invasive devices are external applications, like 3DP models. The medical fields included are anesthesia [1], cardiology [2][3][4][5][6][7][8][9][10][11][12][13], coloproctology [14], dentistry [15][16][17][18], general surgery [19][20][21][22][23][24][25], health care engineering [26,27], hepatology [28], interventional radiology [29], medical education [30][31][32][33][34], neurosurgery [35][36][37][38][39], oncology [40][41][42][43] and radiation oncology [44][45][46]. Further medical fields included are oral and maxillofacial surgery [47][48][49]<...…”

“…Table 3 is sorted according to the medical field (n = 42). The medical fields are dentistry [126,127], general surgery [20,21,24,25] health care engineering [26], neurosurgery [38,[128][129][130][131], oncology [42,43], oral and maxillofacial surgery [47-50, 52, 53, 55, 56], orthopedics [57-59, 63, 67, 68, 73, 77, 132-134], otorhinolaryngology [78,79,83], pediatrics [85,89,90,92] and radiation oncology [44,46]. The affected organs or body parts are the brain [38], cardiothoracic system [89], central nervous system [89], cranium [25, 48-50, 52, 53, 55, 56, 78, 83, 132], ear [78,79,132], eye [132], female internal genitals [44,46], gastrointestinal system [89], genitourinary tract [89], jaw [25, 47-50, 56, 126], liver [25,44], musculoskeletal system [20,21,24,25,…”

“…The pathologies included cancer [21, 25, 42-44, 46, 55, 77, 83, 130], COVID-19 [26], craniofacial defects [47,48,53,56], different fracture types [57,58,63,67,73,132], ear and hearing disorders [78], musculoskeletal malformations [21,67,68,133], neurologic disorders [21,25,38], respiratory disorders [21,79,85], spinal disorders [59,68,92,128,129,134] and tooth loss [126,127]. Procedures include brachytherapy [44,46], cereberovascular surgery [38], colorectal surgery techniques, such as transanal total mesorectal excision, total mesorectal excision, laparoscopic resection [42], craniomoaxillofacial surgery [20, 48-50, 52, 53, 56, 79, 83], guides for dental implants [126], orthopedic procedures on the musculoskeletal system [25,47,55,57,58,63,67,73,…”

“…Lastly composite materials include PC-ABS [42]. Concerning the applications, 3DP is used for only planning [21, 43, 44, 46-49, 52, 53, 56, 57, 63, 67, 68, 73, 78, 90, 92, 126, 127, 130, 133, 134], planning and teaching together [20,24,25,38,55,58,77,79], planning and counseling [50] and planning, teaching and counseling together [42,59,83,85,89]. The most reviews found in this section are from the United States [38,43,44,46,48,49,59,85,89,92,130,132,133].…”

Research on 3D face measurement for facial virtual plastic surgery

“…Every key point of the face is a position in three-dimensional space. Two related points can be connected into a straight line, and two straight lines can form an angle [9][10][11]. By measuring these geometric features, combined with the definition of aesthetics, an aesthetic evaluation model based on the 3D measurement results is established.…”