There Is a Great Future in Plastics: Personalized Approach to the Management of Hilar Cholangiocarcinoma Using a 3-D-Printed Liver Model (original) (raw)
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3D Printing in Liver Surgery: A Systematic Review
Telemedicine Journal and E-health, 2017
Background: Rapid growth of three-dimensional (3D) printing in recent years has led to new applications of this technology across all medical fields. This review article presents a broad range of examples on how 3D printing is facilitating liver surgery, including models for preoperative planning, education, and simulation. Materials and Methods: We have performed an extensive search of the medical databases Ovid/MEDLINE and PubMed/ EMBASE and screened articles fitting the scope of review, following previously established exclusion criteria. Articles deemed suitable were analyzed and data on the 3D-printed modelsincluding both technical properties and desirable applicationand their impact on clinical proceedings were extracted. Results: Fourteen articles, presenting unique utilizations of 3D models, were found suitable for data analysis. A great majority of articles (93%) discussed models used for preoperative planning and intraoperative guidance. PolyJet was the most common (43%) and, at the same time, most expensive 3D printing technology used in the development process. Many authors of reviewed articles reported that models were accurate (71%) and allowed them to understand patient's complex anatomy and its spatial relationships. Conclusions: Although the technology is still in its early stages, presented models are considered useful in preoperative planning and patient and student education. There are multiple factors limiting the use of 3D printing in everyday healthcare, the most important being high costs and the timeconsuming process of development. Promising early results need to be verified in larger randomized trials, which will provide more statistically significant results.
HPB, 2020
Background: Hepatobiliary resections are challenging due to the complex liver anatomy. Threedimensional printing (3DP) has gained popularity due to its ability to produce anatomical models based on the characteristics of each patient. Methods: A multicenter study was conducted on complex hepatobiliary tumours. The endpoint was to validate 3DP model accuracy from original image sources for application in the teaching, patientcommunication, and planning of hepatobiliary surgery. Results: Thirty-five patients from eight centers were included. Process testing between 3DP and CT/ MRI presented a considerable degree of similarity in vascular calibers (0.22 ± 1.8 mm), and distances between the tumour and vessel (0.31 ± 0.24 mm). The Dice Similarity Coefficient was 0.92, with a variation of 2%. Bland-Altman plots also demonstrated an agreement between 3DP and the surgical specimen with the distance of the resection margin (1.15 ± 1.52 mm). Professionals considered 3DP at a positive rate of 0.89 (95%CI; 0.73-0.95). According to student's distribution a higher success rate was reached with 3DP (median:0.9, IQR: 0.8-1) compared with CT/MRI or 3D digital imaging (P = 0.01). Conclusion: 3DP hepatic models present a good correlation compared with CT/MRI and surgical pathology and they are useful for education, understanding, and surgical planning, but does not necessarily affect the surgical outcome.
2018
Intrahepatic cholangiocarcinoma is a tumor from biliary epithelium and, although rare, it is considered the second most prevalent malignant liver tumor, right after hepatocellular carcinoma. It is associated to a high mortality rate, and surgical resection is the only alternative of cure. Surgical resection of intrahepatic cholangiocarcinoma is associated with a 5-year survival rate about 22-36%. Preoperative images, computed tomography and/or magnetic resonance imaging are fundamental tools for surgical planning. Because of the complex nature of hepatic and intrahepatic vascular anatomy, resections are challenging surgeries. 3D printing technology has been slowly adopted in general surgery. This study aimed to report the use of three-dimensional hepatic printing in planning and surgical treatment of an intrahepatic cholangiocarcinoma.
Three-dimensional printing of liver tumors using CT data: proof of concept morphological study
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2018
Hepatocellular carcinoma (HCC) currently represents a major health concern, mainly for its shifting pre-existing conditions that in turn lead to late diagnosis, thus increasing the mortality rate. An improved training of medical personnel involved in diagnosis, staging and the management of treatment is required. We thus aimed to transition tumor view from two-dimensional, on-screen, methods to real, palpatory three-dimensional (3D) representations that can be printed using generally available tools, thus approachable in virtually any medical setting worldwide. After obtaining ethical clearance, we included imaging contrast-enhanced data from 10 confirmed cases of HCC that we translated into a 3D computer render of the tumor with as much morphological data as possible. In addition, we simulated the inner structure of each tumor, simulating different stiffness levels across their respective surfaces, in order to better gauge possible necrosis or vascular particularities. This transla...
Journal of digital imaging, 2017
In the context of medical three-dimensional (3D) printing, in addition to 3D reconstruction from cross-sectional imaging, graphic design plays a role in developing and/or enhancing 3D-printed models. A custom prototype modular 3D model of the liver was graphically designed depicting segmental anatomy of the parenchyma containing color-coded hepatic vasculature and biliary tree. Subsequently, 3D printing was performed using transparent resin for the surface of the liver and polyamide material to develop hollow internal structures that allow for passage of catheters and wires. A number of concepts were incorporated into the model. A representative mass with surrounding feeding arterial supply was embedded to demonstrate tumor embolization. A straight narrow hollow tract connecting the mass to the surface of the liver, displaying the path of a biopsy device's needle, and the concept of needle "throw" length was designed. A connection between the middle hepatic and right p...
Three-dimensional print of a liver for preoperative planning in living donor liver transplantation
Liver Transplantation, 2013
The growing demand for liver transplantation and the concomitant scarcity of cadaveric livers have increased the need for living donor liver transplantation (LDLT). Ensuring the safety of donors and recipients is critical. The preoperative identification of the vascular and biliary tract anatomy with 3-dimensional (3D) printing may allow better preoperative surgical planning, avert unnecessary surgery in patients with potentially unsuitable anatomy, and thereby decrease the complications of liver transplant surgery. We developed a protocol and successfully 3D-printed synthetic livers (along with their complex networks of vascular and biliary structures) replicating the native livers of 6 patients: 3 living donors and 3 respective recipients who underwent LDLT. To our knowledge, these are the first complete 3D-printed livers. Using standardized preoperative, intraoperative, and postoperative assessments, we demonstrated identical anatomical and geometrical landmarks in the 3D-printed models and native livers.
Materials Today: Proceedings, 2020
The review study considers the three-dimensional printing for anatomical simulations and their potential surgical applications. Three-dimensional (3D) printing has entirely transform the current era with its state-of-art usefulness and applications. The functional usability of three-dimensional printed models has been mentioned for orthopaedic, neurosurgery, heart valve surgery, and malignant tissues. Surgical planning of congenital anomalies has also pondered. By 3D printed models, surgical anatomical teaching methods have been explained. The key significance of 3D printed models during treatment of benign and cancerous tumors have been pointed with the conception of bone grinding. In final section, the complications and merits of 3D printed models in surgery have been postulated along with the ethical concerns associated with 3D printed models.
3D Printing of Prototypes Starting from Medical Imaging: A Liver Case Study
Springer eBooks, 2021
Hepatic diseases are serious condition worldwide, and several times doctors analyse the situation and elaborates a preoperative planning based exclusively on the medical images, which are a drawback since they only provide a 2D vision and the location of the damaged tissues in the three-dimensional space cannot be easily determined by surgeons. Nowadays, with the advancement of Computer Aided Design (CAD) technologies and image segmentation, a digital liver model can be obtained to help understand the particular medical case; even with the geometric model, a virtual simulation can be elaborated. This work is divided into two phases; the first phase involves a workflow to create a liver geometrical model from medical images. Whereas the second phase provides a methodology to achieve liver prototype, using the technique of fused deposition modelling (FDM). The two stages determine and evaluate the most influencing parameters to make this design repeatable in different hepatic diseases. The reported case study provides a valuable method for optimizing preoperative plans for liver disease. In addition, the prototype built with additive manufacturing will allow the new doctors to speed up their learning curve, since they can manipulate the real geometry of the patient's liver with their hands.
3D printing to simulate laparoscopic choledochal surgery
Journal of Pediatric Surgery, 2016
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