A systematic review of the application of 3D-printed models to colorectal surgical training

3D-reconstruction printed models could enhance understanding of Crohn's disease complex perianal fistulas?

BACKGROUND

3D image processing and reconstruction (3D-IPR) is increasingly used in surgical applications for enhanced planning and intraoperative visualization. 3D-printed models, created from 3D-IPR, have the potential to improve understanding of anatomical structures and simulate surgical procedures. However, evidence supporting their educational benefits, particularly for complex perianal Crohn's disease (pCD) fistulas, remains limited.

METHODS

This study assessed the role of 3D-printed models as teaching tools for general surgery and gastroenterology trainees/attendants. Two courses were developed, incorporating pre-tests, lessons, real case presentations with MRI scans, and discussions using 3D-printed models. Pre- and post-course test scores were analyzed to evaluate learning outcomes.

RESULTS

Participants demonstrated significant improvement in post-test scores compared to pre-test scores, highlighting the educational impact of 3D models. Course satisfaction surveys revealed high satisfaction, with most participants likely to recommend the course.

CONCLUSIONS

3D-IPR and 3D-printed models hold promise as effective tools for teaching complex pCD anatomy, enhancing surgical education, and improving understanding of 3D structures. These findings enhance the growing importance of integrating 3D technologies into modern surgical training.

Design and validation of a simulation-based training module for ileo-transverse intracorporeal anastomosis

BACKGROUND

The benefits of the totally laparoscopic right hemicolectomy have been established, but its adoption has been limited by the challenges of intracorporeal suturing. While simulation is effective for training advanced surgical skills, no dedicated simulation-based course exists for intracorporeal ileo-transverse anastomosis (ICA). This study aimed to develop and validate a simulation module for training in ICA.

METHODS

This study employed a proof-of-concept design for an educational tool. Key aspects of the anastomosis were identified using the team's surgical experience, surgical videos, and existing evidence. Surgeons were recruited to test and refine successive simulation models through an iterative process until a functional prototype was achieved and assessed. Subsequently, surgeons with varying experience levels were invited to perform an ICA in the model. Performance was evaluated by two blinded surgeons through video recordings, utilizing a modified Objective Structured Assessment of Technical Skills (OSATS), a Specific Rating Score (SRS), and operative time measurements. Non-parametric descriptive and analytical methods were applied, with results presented as median [IQR].

RESULTS

An ex vivo based model was developed. Seventeen participants evaluated the model. Eighty-three percent declared acceptable or maximum fidelity regarding the colon. Resemblance to the surgical scenario in terms of ergonomic and anatomical similarity was highlighted. All participants found the model useful to train intracorporeal suturing. Thirteen subjects performed the ICA. Experts achieved significantly higher OSATS scores (22.3 [22-22.5] vs 18 [16-19.5]; p = .013), exhibited a trend toward higher SRS, and obtained shorter operative times (21.5 vs 36 min; p = .039).

CONCLUSION

An ex vivo simulation module for ICA was developed, demonstrating acceptable fidelity in replicating the surgical environment. The simulated scenario could successfully distinguish between levels of surgical experience, as evidenced by significant differences in OSATS scores and operative times, thereby confirming its construct validity.

Impact of innovative technologies on quality and safety in surgery

Technological advancements gradually lead to the revision and transformation of healthcare, training, and research. Surgery is a field of medicine where the collaboration of human resources and the application of innovative technologies could elevate faithfulness and efficiency. The article, exploring the technologies and analyzing them in terms of their reliability, the benefits of performing precision surgeries, the effectiveness in the outcome of surgery with less psychosomatic fatigue, and the improvements in the training process for surgeons, emphasizes the safety and quality that can be achieved. The study was conducted by searching the relevant papers mainly from 2016-2024 using different online databases such as Web of Science, Google Scholar, and PubMed to examine the impact of adopting new technologies in medicine. This paper highlights that the use of innovative technologies in a wide range of surgical procedures could, by adapting interdisciplinary procedures, provide significant results in issues related to safety, quality, reliability, and training.

3D-reconstruction printed models and virtual reality improve teaching in oncological colorectal surgery

BACKGROUND

This study aimed to evaluate the use of 3D image processing and reconstruction (3D-IPR) combined with virtual reality (VR) technology and printed models (PM) as teaching tools in oncological colorectal surgery.

METHODS

We designed two courses, one for general surgery trainees and another for young colorectal surgeons, structured around stations of pre-test, anatomical lessons, real-case presentations, 3D-IPR models, VR experiences, and life-size abdominal PM with surgical approach explanations and a final post-test.

RESULTS

Fourteen course participants were evaluated. Pre-test scores averaged 5.15, with a median of 5.5, while post-test scores increased to an average of 7.75, with a median score of 8. Course satisfaction surveys indicated high ratings for expectations, duration, relevance, presenter knowledge, teaching materials, communication, and overall course segments, with an average rating exceeding 4.8 out of 5. Results highlight the potential of 3D-IPR, VR, and PM as tools for improving teaching for surgery residents and colorectal surgeons. These technologies offer immersive, risk-free experiences for learners, potentially enhancing skill acquisition and anatomical understanding.

CONCLUSION

This study demonstrates the effectiveness of 3D-IPR, VR, and PM courses in improving understanding of colorectal surgery. As these technologies continue to advance, they offer enhanced immersion and accessibility, transforming surgical education and medical training.

Creation of a Novel Ex Vivo 3D Printed Ileal Conduit Task Trainer for Teaching Conduitoscopy Skills

OBJECTIVE

To perform endoscopy in patients with urinary diversions requires specific endoscopic skills, which can currently only be gained in clinical practice. We created a 3D-printed ex vivo ileal conduit model (stoma and conduit with ureters and 2 kidneys) to simulate "conduitoscopy" and evaluated the realism and limitations of the model.

METHODS

Accurate anatomical features were represented using an appropriate reusable design, realistic mechanical qualities with several material types, and 3D-printed components. Different models of bowel and ureters were assessed by the subject-matter experts (SME). The final ileal conduit model (Wallace 1 type anastomosis) was evaluated by 18 SMEs.

RESULTS

Most experts gave their approval to the view of the stoma, as well as the appearance of the bowel, ureteric, and pelvicalyceal systems. A total of 72.1% of SMEs approved the ureteric endoscopic view compared to about 66% who accepted the endoscopic examination of the bowel. The model's overall appearance was good for 61.1% and excellent for 38.8% of experts.

CONCLUSION

Conduitoscopy simulation training can now be facilitated using our novel and unique cutting-edge 3D-printed model. We created a model that is highly anatomically accurate and workable. In our study, anatomical and visual realism was demonstrated. The next step would be increasing the length of the conduit and conduct a validation study.

The evolution of simulation-based medical education research: From traditional to virtual simulations

Background

Simulation-based medical education (SBME) is a widely used method in medical education. This study aims to analyze publications on SBME in terms of countries, institutions, journals, authors, and keyword co-occurrence, as well as to identify trends in SBME research.

Methods

We retrieved the Publications on SBME from the Web of Science Core Collection (WoSCC) database from its inception to January 27, 2024. Microsoft Excel 2019, CiteSpace, and VOSviewer were used to identify the distribution of countries, journals, and authors, as well as to determine the research hotspots.

Results

We retrieved a total of 11272 publications from WoSCC. The number of documents published in 2022 was the highest in the last few decades. The USA, the UK, and Canada were three key contributors to this field. The University of Toronto, Stanford University, and Harvard Medical School were the top major institutions with a larger number of publications. Konge, Lars was the most productive author, while McGaghie, William C was the highest cited author. BMC Medical Education has the highest number of publications among journals. The foundational themes of SBME are "Patient simulation," "extending reality," and "surgical skills."

Conclusions

SBME has attracted considerable attention in medical education. The research hotspot is gradually shifting from traditional simulations with real people or mannequins to virtual, digitally-based simulations and online education. Further studies will be conducted to elucidate the mechanisms of SBME. The utilization of SBME will be more rationalized.

Clinical applications of 3D printing in colorectal surgery: A systematic review

BACKGROUND

The utilization of three-dimensional printing has grown rapidly within the field of surgery over recent years. Within the subspecialty of colorectal surgery, the technology has been used to create personalized anatomical models for preoperative planning, models for surgical training, and occasionally customized implantable devices and surgical instruments. We aim to provide a systematic review of the current literature discussing clinical applications of three-dimensional printing in colorectal surgery.

METHODS

Full-text studies published in English which described the application of 3D printing in pre-surgical planning, advanced surgical planning, and patient education within the field of colorectal surgery were included. Exclusion criteria were duplicate articles, review papers, studies exclusively dealing with surgical training and/or education, studies which used only virtual models, and studies which described colorectal cancer only as it pertained to other organs.

RESULTS

Eighteen studies were included in this review. There were two randomized controlled trials, one retrospective outcomes study, five case reports/series, one animal model, and nine technical notes/feasibility studies. There were three studies on advanced surgical planning/device manufacturing, six on pre-surgical planning, two on pelvic anatomy modeling, eight on various types of anatomy modeling, and one on patient education.

CONCLUSIONS

While more studies with a higher level of evidence are needed, the findings of this review suggest many promising applications of three-dimensional printing within the field of colorectal surgery with the potential to improve patient outcomes and experiences.

Developing a phantom for simulating robotic-assisted complete mesocolic excision using 3D printing and medical imaging

BACKGROUND

Robotic-assisted complete mesocolic excision is an advanced procedure mainly because of the great variability in anatomy. Phantoms can be used for simulation-based training and assessment of competency when learning new surgical procedures. However, no phantoms for robotic complete mesocolic excision have previously been described. This study aimed to develop an anatomically true-to-life phantom, which can be used for training with a robotic system situated in the clinical setting and can be used for the assessment of surgical competency.

METHODS

Established pathology and surgical assessment tools for complete mesocolic excision and specimens were used for the phantom development. Each assessment item was translated into an engineering development task and evaluated for relevance. Anatomical realism was obtained by extracting relevant organs from preoperative patient scans and 3D printing casting moulds for each organ. Each element of the phantom was evaluated by two experienced complete mesocolic excision surgeons without influencing each other's answers and their feedback was used in an iterative process of prototype development and testing.

RESULTS

It was possible to integrate 35 out of 48 procedure-specific items from the surgical assessment tool and all elements from the pathological evaluation tool. By adding fluorophores to the mesocolic tissue, we developed an easy way to assess the integrity of the mesocolon using ultraviolet light. The phantom was built using silicone, is easy to store, and can be used in robotic systems designated for patient procedures as it does not contain animal-derived parts.

CONCLUSIONS

The newly developed phantom could be used for training and competency assessment for robotic-assisted complete mesocolic excision surgery in a simulated setting.