An overview on 3D printing for abdominal surgery
- 10 Downloads
Three-dimensional (3D) printing is a disruptive technology that is quickly spreading to many fields, including healthcare. In this context, it allows the creation of graspable, patient-specific, anatomical models generated from medical images. The ability to hold and show a physical object speeds up and facilitates the understanding of anatomical details, eases patient counseling and contributes to the education and training of students and residents. Several medical specialties are currently exploring the potential of this technology, including general surgery.
In this review, we provide an overview on the available 3D printing technologies, together with a systematic analysis of the medical literature dedicated to its application for abdominal surgery. Our experience with the first clinical laboratory for 3D printing in Italy is also reported.
There was a tenfold increase in the number of publications per year over the last decade. About 70% of these papers focused on kidney and liver models, produced primarily for pre-interventional planning, as well as for educational and training purposes. The most used printing technologies are material jetting and material extrusion. Seventy-three percent of publications reported on fewer than ten clinical cases.
The increasing application of 3D printing in abdominal surgery reflects the dawn of a new technology, although it is still in its infancy. The potential benefit of this technology is clear, however, and it may soon lead to the development of new hospital facilities to improve surgical training, research, and patient care.
KeywordsThree-dimensional printing Additive manufacturing Rapid prototyping Virtual reconstruction Simulation for surgery
The authors want to acknowledge Ms. Chiara Rebuffi (Fondazione IRCCS Policlinico San Matteo, Scientific Library) for her support in the definition of the search strings on scientific databases. The present work has been supported by the research project “Pancreatic ductal adenocarcinoma (PDAC): development of a new communication platform between radiologists, surgeons and pathologists based on virtual and 3D printed reconstructions of the pancreas and the tumor mass” (PE-2013-02358887) funded by the Italian Ministry of Health. The study falls under the framework of the 3D@UniPV project (ww.unipv.it/3d), one of the strategic research areas of the University of Pavia.
Compliance with ethical standards
Andrea Pietrabissa, Stefania Marconi, Erika Negrello, Valeria Mauri, Andrea Peri, Luigi Pugliese, Enrico Maria Marone e Ferdinando Auricchio have no conflicts of interest or financial ties to disclose.
- 1.ASTM F2792-12a (2012) Standard terminology for additive manufacturing technologies (withdrawn 2015). ASTM International, West Conshohocken. www.astm.org
- 2.RefWorks software Copyright© 2019 ProQuest LLCGoogle Scholar
- 5.Sugimoto M (2014) New multicolored multimaterial bioelastic organ replication using hybrid mdct and 3D printing technology for tangible digestive surgery simulation. United European Gastroenterol J 2(1):a198Google Scholar
- 6.Shiga Y, Sugimoto M, Iwabuchi T, Kawano Y, Yokoyama H, Ooiwa Y, Shimmbori M, Hariu K, Yamamoto R (2014) Benefit of three-dimensional printing in robotic laparoscopic renal surgery: tangible surgical navigation using a patient-based three-dimensional printed kidney. Urology 84(4):s256–s257Google Scholar
- 7.Sugimoto M (2014) Patient-specific bio-elastic organ manufacturing by multi-material 3D printer in laparoscopic surgery simulation and navigation. Surg Endosc 20:s10Google Scholar
- 10.Sugimoto M (2012) Bio-texture modeling technology of gastrointestinal hepatobiliary pancreatic organs by multimaterial 3D printing system. Gastroenterology 142(5):s345Google Scholar
- 12.Chandak P, Byrne N, Karunanithy N, Stojanovic J, Marks SD, Uwechue R, Gogalniceanu P, Kessaris N, Mamode N (2017) Clinical use of 3D printing in complex pediatric renal transplantation—a phase 2A study of the ideal framework. Transpl Int 30:157Google Scholar
- 14.Chandak P, Byrne N, Karunanithy N, Callaghan C, Mushtaq I, Marks SD, Stojanovic J, Ahmed Z, Kessaris N, Mamode N (2016) Using 3D printing in complex pediatric renal transplantation. Am J Transplant 16:749–750Google Scholar
- 21.Ghazi A, Campbell T, Melnyk R, Feng C, Andrusco A, Stone J and Erturk E (2017) Validation of a full-immersion simulation platform for percutaneous nephrolithotomy using 3D printing technology. J EndourolGoogle Scholar
- 27.Condino S, Carbone M, Ferrari V, Alberti A, Forestieri F, Cioni R, Caramella D, Ferrari M, Mosca F (2011) Fabrication strategy to build a patient specific physical simulator for endovascular training. Int J Comput Assist Radiol 6:s272–s273Google Scholar
- 30.Nahkahn JY, Lee GH, Lee JH, Kim DH, Yung KW, Choi KD, Song HJ, Yung HY (2018) The efficacy of a novel percutaneous endoscopic gastrostomy simulator using three-dimensional printing technologies. J Gastroenterol Hepatol 34(4):659–665Google Scholar
- 31.Witowski J, Sitkowski M, Wysocki M, Malina Z, Malczak P, Major P, Pedziwiatr M, Budzynski A (2018) 3D printing in laparoscopic liver resections: an initial experience. Surg Endosc 32(1):s271Google Scholar
- 32.Kanngott HG, Wunscher JJ, Wagner M, Preukschas A, Wekerle AL, Neher P, Suwelack S, Speidel S, Nickel F, Oladokun D, Maier-Hein L, Dillmann R, Meinzer P, Muller-Stich BP (2015) OpenHELP (Heidelberg Laparoscopic Phantom): development of an open-source surgical evaluation and training tool. Surg Endosc 29(11):3338–3347CrossRefGoogle Scholar
- 34.Asthana S, Lochan R, Jacob M, Medappil N, Reddy J, Saif R, Raja K, Panackel C, Sakpal M, Ganjoo N (2018) Three-dimensional printing with biotexture modeling assisted donor left hepatectomy. Transplantation 102(5):130Google Scholar
- 38.Porpiglia F, Bertolo R, Checcucci E, Amparore D, Autorino R, Dasgupta P, Wiklund P, Tewari A, Liatsikos E, Fiori C (2017) Development and validation of 3D printed virtual models for robot-assisted radical prostatectomy and partial nephrectomy: urologists’ and patients’ perception. World J Urol 36(2):201–207CrossRefGoogle Scholar
- 43.Bernhard JC, Isotani S, Matsugasumi T, Duddalwar V, Hung AJ, Suer E, Baco E, Satkunasivam R, Djaladat H, Metcalfe C, Hu B, Wong K, Park D, Nguyen M, Hwang D, Bazargani ST, De Castro Abreu AL, Aron M, Ukimura O, Gill IS (2016) Personalized 3D printed model of kidney and tumor anatomy: a useful tool for patient education. World J Urol 34(3):337–345CrossRefGoogle Scholar
- 45.Souzaki R, Kinoshita Y, Ieiri S, Hayashida M, Koga Y, Shirabe K, Hara T, Maehara Y, Hashizume M, Taguchi T (2015) Three-dimensional liver model based on preoperative CT images as a tool to assist in surgical planning for hepatoblastoma in a child. Pediatr Surg Int 31(6):593–596CrossRefGoogle Scholar
- 49.Vernez SL, Spradling K, Dolan B, Dutta R, Okhunov Z, Youssef RF, Kaler K, Landman J, Clayman RV (2016) Three-dimensional printed kidney models with extensive urolithiasis: an over resident educational tool for planning percutaneous nephrolithotomy. J Urol 195(4):e212–e213Google Scholar
- 52.Rajagopal V, Janardan R, Miyaoka R, Monga M, Sweet RM (2009) Modeling and simulation for flexible utheroscopy. J Endourol 23(6):1035–1036Google Scholar
- 62.Porpiglia F, Bertolo R, Checcucci E, Amparore D, Autorino R, Dasgupta P, Wiklund P, Tewari A, Liatsikos E, Fiori C (2018) Development and validation of 3D printed virtual models for robot-assisted radical prostatectomy and partial nephrectomy: urologists’ and patients’ perception. World J Urol 36(2):201–207CrossRefGoogle Scholar
- 66.Atalay HA, Ulker V, Alkan I, Canat HL, Ozkuvanci U, Altunrende F (2016) Impact of three-dimensional printed pelvicaliceal system models on residents’ understanding of pelvicaliceal system anatomy before percutaneous nephrolithotripsy surgery: a pilot study. J Endourol 30(10):1132–1137CrossRefGoogle Scholar
- 71.Bundy JJ, Weadock WJ, Chick JFB, Srinivasa RN, Patel N, Jonson E, Khayat M, Jeffers B, Gemmete JJ, Srinivasa RN (2018) Three-dimensional printing facilitates creation of a biliary endoscopy phantom for interventional radiology-operated endoscopy training. Curr Probl Diagn Radiol 48:456–461CrossRefGoogle Scholar
- 73.Sanchez-Sanchez A, Giron-Vallejo O, Ruiz-Pruneda R, Fernandez-Ibieta M, Garcia-Calderon D, Villamil V, Gimenez-Aleixandre MC, Montoya-Rangel CA, Bermejo JPH (2018) Three-dimensional printed model and virtual reconstruction: an extra tool for pediatric solid tumors surgery. Eur J Pediatr Surg Rep 6(1):e70–e76CrossRefGoogle Scholar
- 75.Holzem KM, Jayarajan S, Zayed MA (2018) Surgical planning with three-dimensional printing of a complex renal artery aneurysm. J Vasc Surg 4(1):19Google Scholar
- 76.Schwaiger J, Kagerer M, Traeger M, Gillen S, Dobritz M, Kleeff J, Feussner H and Lueth TC (2012) Manufacturing of patient-specific pancreas models for surgical resections. In: IEEE international conference on robotics and biomimetics (Robio 2012)Google Scholar
- 84.Celby JB, Heaton CM, Rosen D (2011) Intervention planning tool incorporating rapid prototyping and manufacturing technologies for vascular/interventional radiologists. Int J Comput Assist Radiol 6:s337Google Scholar
- 86.Luzon JA, Andersen BT, Stimec BV, Fasel JHD, Bakka AO, Kazaryan AM, Ignjatovic D (2018) Implementation of 3D-printed superior mesenteric vascular models for surgical planning and/or navigation in right colectomy with extended D3 mesenterectomy: comparison of virtual and physical models to the anatomy found at surgery. Surg Endosc 33(2):567–575CrossRefGoogle Scholar
- 89.Ng TL, Li CF, Kan WM, Ng CM, Kan CF, Ngai HY, Au WH (2017) 3D printing of kidney models for urological surgeries: our initial experience. Int J Urol 24:45Google Scholar
- 90.Rude T, Wake N, Sodickson DK, Stifelman M, Borin J, Chandarana H, Huang WC (2016) An analysis of the effect of 3D printed renal cancer models on surgical planning. Int J Comput Assist Radiol 11(1):s91Google Scholar
- 91.Que W, Zong L (2016) Application of 3D printing techniques in pediatric living donor liver transplantation. Transplantation 100(5):s170–s171Google Scholar
- 92.Souzaki R, Kinoshita Y, Ieiri S, Kawakubo N, Koga Y, Jimbo T, Obata S, Miyoshi K, Kohashi K, Oda Y, Hara T, Hashizume M, Taguchi T (2015) Efficacy of three-dimensional printing model based on preoperative CT images for the surgery of pediatric malignancies. Pedriatr Blood Cancer 62:s189Google Scholar
- 93.Kumar R, Rao N, Ramachandran R, Singh P, Tandon N (2014) Laparoscopic adrenalectomy for pheochromocytoma: comparative outcome analysis of small versus large tumors. Int J Urol 21:a111–112Google Scholar
- 94.Wallach D, Peterhans M, Brun B, Banz V, Candinas D, Weber S (2012) Development of a surgical template system for application in image guided liver surgery. HBP 14:131Google Scholar
- 95.Byun SS, Lee H, Hong SK, Lee SE (2018) Personalized 3D kidney model produced by rapid prototyping method and its usefulness in clinical applications. Int J Urol 25:362Google Scholar
- 100.Nickel F, Hendrie JD, Kowalewski KF, Bruckner T, Garrow CR, Mantel M, Kenngott HG, Romero P, Fischer L, Müller-Stich BP (2016) Sequential learning of psychomotor and visuospatial skills for laparoscopic suturing and knot tying—a randomized controlled trial “The Shoebox Study” DRKS00008668. Langenbecks Arch Surg 401(6):893–901CrossRefPubMedGoogle Scholar
- 101.Marone EM, Rinaldi LF, Pietrabissa A, Argenteri A (2017) Effectiveness of 3D printed models in obtaining informed consent to complex aortic surgery in 25 patients. J Cardiovasc Surg 59(3):488–489Google Scholar