Experiences With Three-dimensional Printing in Complex Liver Surgery

Abstract

Objective: We present a series of cases where we used 3D printing in planning of complex liver surgery. Background: In liver surgery, three-dimensional reconstruction of the liver anatomy, in particular of vascular structures, has shown to be helpful in operation planning. So far, 3D printing has been used for medical applications only rarely. Methods and Patients: From December 2017 to December 2019, in 10 cases where surgery was assumed to be challenging operation planning was performed using full size 3D prints in addition to standard 3 phase CT scans. Models included transparent parenchyma, hepatic veins, vena cava, portal vein, hepatic artery, (biliary tree if requested), and tumors. In 7/10 cases vascular reconstructions were needed during the procedure. Nonstructured feedback of the surgical team revealed that the major benefit was visualization of the critical areas of vascular reconstruction, the expected dimensions of tangential vascular infiltration and the planning of reconstruction. In the multifocal tumors, 3D prints were considered to be helpful for intraoperative orientation to detect metastases and to improve planning of the resection. Conclusions: In complex liver surgery with potential need for vascular reconstructions operation planning may be optimized using a 3D printed liver model. Prospective studies are needed to evaluate the clinical impact of 3D printing in liver surgery compared to other 3D visualizations.

Using virtual 3D-models in surgical planning: workflow of an immersive virtual reality application in liver surgery

“…The demonstration of the system to the HPB experts was independent of a specific surgical procedure. Thus, we used cases that were available in our collection of 3D reconstructions that have been printed for surgical planning [ 6 ]. Thus, intraoperative feedback regarding the preoperative visualization in immersive VR from the surgeons was not collected and will be part of future investigations in a clinical trial.…”

“…To date, these 3D reconstructions are mostly presented as 3D PDFs and only rarely as 3D-printed models. Some publications describe the presentation in preoperative planning by means of a 3D-printed model [4,5] that gives a good impression of tumor location especially in multifocal tumor burden and when vascular invasion with the necessity of reconstruction is suspected [6]. The potential drawback of 3D prints is a time delay for the printing process and higher costs [7].…”

Liver Resection for Intrahepatic Cholangiocarcinoma—Single-Center Experience with 286 Patients Undergoing Surgical Exploration over a Thirteen Year Period

“…In addition, computer-assisted operation planning and 3D reconstruction of liver anatomy that may provide significant anatomical information. In recent years, we used 3D-prints of the liver for operation planning in selected cases [9]. Although very instructive, it needs to be evaluated whether these techniques can also contribute to a better assessment of resectability, to a reduction of perioperative morbidity and mortality and finally to an improvement of the oncological outcome.…”

“…These were performed either by an external provider (MeVis Distant Services, MeVis AG, Bremen, Germany) or with a local reconstruction software (Synapse 3D, Fujifilm AG, Tokyo, Japan) by a trained surgical resident [8]. Since 2017, 3D-prints of the liver were performed on special request of the surgeon with nonflexible polyurethane rubber [9]. Especially in cases with anticipated complex vascular reconstructions, 3D-prints were ordered for preoperative planning (Figure 1).…”

Virtual reality and 3D printing improve preoperative visualization of 3D liver reconstructions—results from a preclinical comparison of presentation modalities and user’s preference

“…In addition, the different structures (e.g., tumor) can be displayed solid, transparently or hidden. (II) PR: The 3D models were printed by Cella Medical Solutions (Murcia, Spain) using the STL files, which are generated by the reconstruction software as previously described (16). For the parenchyma a transparent material (polyurethane rubber) is used, so that the colored structures (acrylonitrile butadiene styrene with pigments) in the inside (e.g., vessels, tumor) can be seen.…”