Decision-making based on 3D printed models in laparoscopic liver resections with intraoperative ultrasound: a prospective observational study

Abstract

Objectives The aim of this study was to evaluate impact of 3D printed models on decision-making in context of laparoscopic liver resections (LLR) performed with intraoperative ultrasound (IOUS) guidance. Methods Nineteen patients with liver malignances (74% were colorectal cancer metastases) were prospectively qualified for LLR or radiofrequency ablation in a single center from April 2017 to December 2018. Models were 3DP in all cases based on CT and facilitated optical visualization of tumors' relationships with portal and hepatic veins. Planned surgical extent and its changes were tracked after CT analysis and 3D model inspection, as well as intraoperatively using IOUS. Results Nineteen patients were included in the analysis. Information from either 3DP or IOUS led to changes in the planned surgical approach in 13/19 (68%) patients. In 5/19 (26%) patients, the 3DP model altered the plan of the surgery preoperatively. In 4/19 (21%) patients, 3DP independently changed the approach. In one patient, IOUS modified the plan post-3DP. In 8/19 (42%) patients, 3DP model did not change the approach, whereas IOUS did. In total, IOUS altered surgical plans in 9 (47%) cases. Most of those changes (6/9; 67%) were caused by detection of additional lesions not visible on CT and 3DP. Conclusions 3DP can be helpful in planning complex and major LLRs and led to changes in surgical approach in 26.3% (5/19 patients) in our series. 3DP may serve as a useful adjunct to IOUS. Key Points • 3D printing can help in decision-making before major and complex resections in patients with liver cancer. • In 5/19 patients, 3D printed model altered surgical plan preoperatively. • Most surgical plan changes based on intraoperative ultrasonography were caused by detection of additional lesions not visible on CT and 3D model.

3D Printing of Physical Organ Models: Recent Developments and Challenges

“…Kuroda et al [10] used TPE to 3D print blood vessels and plaster to print mold, also molded liver parenchyma with soft polyurethane. Witowski et al [95] used PLA to 3D print blood vessels and tumors of the liver and print the mold, then cast with transparent silicone to make the liver parenchyma. Adams et al [82] directly 3D printed wax to make the collecting system of kidney, then printed photosensitive resin molds and casted with silicone, agarose gel and PDMS respectively to produce three different renal parenchyma, but it is noteworthy that they finally dissolved the wax in ethanol to remove the wax, therefore it can also be considered a completely indirect method.…”

“…Reproduced under terms of the CreativeCommons CC‐BY license. [ 95 ] Copyright 2019, The Authors. Published by Springer Nature.…”

Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: abdominal, hepatobiliary, and gastrointestinal conditions

“…The majority of intrahepatic masses requiring resection in adults includes hepatocellular carcinoma and isolated or few intrahepatic metastases, such as colorectal metastasis [51]. Anatomic models have been used in preoperative planning for surgical resection of hepatic masses [19,21,52]. Specifically, 3D printed anatomic models may be helpful in the resection of hepatic tumors through demonstrating the relationship of the tumor in regards to its location within hepatic segments, invasion or proximity to major hepatic or portal veins, arteries, and bile ducts.…”

Invited commentary: Personalized surgical planning by computational and visual methods in 21st‐century medical engineering

“…A domain of particular interest and growth has been in personalized surgical planning, whereby clinical teams previsualize and plan the optimal treatment strategy given the pathology and patient-specific anatomic challenges. [1][2][3] Realization of milestone achievements in surgical planning stem from substantial advancements in computational modeling (computational fluid dynamics [CFD], finite element analysis, and fluid-structure interaction [FSI] studies), cutting-edge imaging methods (3D/4D magnetic resonance images [MRI], CT, SPECT scans, ultrasound), and state-of-the-art 3D rapid prototyping. CFD simulations were formerly reserved for the most complex applications, because the solutions required extensive computational power, time, and resources, which limited widespread use.…”

“…To address these challenges, clinicians, engineers, and scientists seek to innovate novel technology‐driven and discovery‐driven therapies that will transform clinical care, treatment, and outcomes for all patients. A domain of particular interest and growth has been in personalized surgical planning, whereby clinical teams previsualize and plan the optimal treatment strategy given the pathology and patient‐specific anatomic challenges 1–3 …”