Impact of personalized three-dimensional (3D) printed pelvicalyceal system models on patient information in percutaneous nephrolithotripsy surgery: a pilot study

Abstract

Objective To investigate the impact of personalized three dimensional (3D) printed pelvicalyceal system models on patient information before percutaneous nephrolithotripsy surgery.Material and Methods Patients with unilateral complex renal stones with indicatation of percutaneous nephrolithotripsy surgery were selected. Usable data of patients were obtained from CT scans as Digital Imaging and Communications in Medicine (DICOM) format. Mimics software version 16.0 (Materialise, Belgium) was used for segmentation and extraction of pelvicalyceal systems. DICOM format were converted to Stereolithography file format. Finally, fused deposition modeling was used to create plasticine 3D models of pelvicalyceal systems. A questionnaire was designed for patients to assess personalized 3D models effect on patient’s understanding their conditions before percutaneous nephrolithotripsy surgery (PCNL). The day before surgery, each patient was seen by a urologist to deliver information about surgery. Questionnaire forms were asked to patients complete before and after presentation of 3D models and the results of the questions were compared.Results Five patient’s anatomically accurate models of the human renal collecting system were successfully generated. After the 3D printed model presentation, patients demonstrated an improvement in their understanding of basic kidney anatomy by 60% (p=0.017), kidney stone position by 50% (p=0.02), the planned surgical procedure by 60% (p=0.017), and understanding the complications related to the surgery by 64% (p=0.015). In addition, overall satisfaction of conservation improvement was 50% (p=0.02).Conclusion Generating kidney models of PCSs using 3D printing technology is feasible, and understandings of the disease and the surgical procedure from patients were well appreciated with this novel technology.

A systematic review of clinical value of three-dimensional printing in renal disease

“…Cost of printing 3D kidney models is another challenge, and this depends on the type of 3D printers and materials used for 3D printing. This review shows that with use of low-cost materials or home-made 3D printers, the cost associated with 3D printed kidney models is less than USD$150, as shown in some studies (25,27,28,33). However, a high quality kidney model printed with flexible materials such as TangoPlus and with different colours to highlight renal tumours and vascular or renal collecting structures can cost up to USD$1,000 (15,16,18,26).…”

“…Three of them showed that patient's understanding of renal anatomy and pathology was improved with use of 3D printed models, with patient's satisfaction score more than 9 out of 10 (15,25,31). Another three studies demonstrated the clinical value of using 3D printed models in pre-operative planning or simulation of surgical procedures, which led to reduction of surgery duration and intraoperative complications, as well as assisting renal transplantation surgery (17,27,28).…”

“…Of 19 eligible studies, 4 were further excluded because of duplicate publication in 2 studies by the same research group (20,21), while another 2 studies focused on 3D printed renal compartments for nuclear medicine imaging without reporting any clinical application of 3D printed models in renal anatomy or renal disease (22,23). Thus, a total of 15 articles were finally included in this review (15)(16)(17)(18)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Figure 2 shows the search strategy to identify these eligible studies.…”

“…There are 7 studies reporting the qualitative assessment of 3D printed models in renal disease (15,17,(25)(26)(27)(28)31). Three of them showed that patient's understanding of renal anatomy and pathology was improved with use of 3D printed models, with patient's satisfaction score more than 9 out of 10 (15,25,31).…”

Three-dimensional Printing Versus Conventional Machining in the Creation of a Meatal Urethral Dilator: a Cost and Mechanical Strength Analysis

“…Discussion 3D printing is a promising new technology that has the potential to revolutionise medicine. Many non-invasive uses for 3D printing in urology have been explored ranging from surgical simulation (14-17), histopathological correlation (18,19), augmented reality surgery (20,21) and anatomical models (5,6,(22)(23)(24)(25). However, the next frontier in 3D printing research is the development of clinically useful 3D printed equipment, tools and implants.…”