Preoperative surgical simulation of laparoscopic adrenalectomy for neuroblastoma using a three-dimensional printed model based on preoperative CT images

Three-Dimensional Physical Model in Urologic Cancer

Three-dimensional (3D) printing, as an evolving technology, enables the creation of patient-specific physical models with high precision; thus, it is widely used in various clinical practices, especially urologic cancer. There is an increasing need to clarify the contribution of 3D printing in the practice of urological cancer in order to identify various applications and improve understanding its benefits and challenges in clinical practice. Researches have focused on the use of 3D-printed models in patient and trainee education, surgical simulation, as well as surgical planning and guidance. This mini review will present the most recently published studies on the topic, including the applications of 3D-printed models, feasibility of performed procedures, possible simulated organs, application outcomes, and challenges involved in urologic cancer, to provide potential directions for future research.

3D surgical planning of pediatric tumors: a review

BACKGROUND

3D surgical planning for the treatment of tumors in pediatrics using different neuroimaging methods is witnessing an accelerating and dynamic development. Until now, there have been many reports on the use of 3D printing techniques in different aspects of medical practice. Pediatric tumors mainly in the abdomen are among the most medical specialties that benefit from using this technique. The purpose of the current study is to review published literature regarding 3D surgical planning and its applications in the treatment of pediatric tumors and present challenges facing these techniques.

MATERIALS AND METHODS

A completed review of the available literature was performed, effect sizes from published studies were investigated, and results are presented concerning the use of 3D surgical planning in the management of pediatric tumors, most of which are abdominal.

RESULTS

According to the reviewed literature, our study comes to the point that 3D printing is a valuable technique for planning surgery for pediatric tumors in heart, brain, abdomen and bone. MRI and CT are the most common used techniques for preparing 3D printing models, as indicated by the reviewed reports. The reported studies have indicated that 3D printing allows the understanding of the anatomy of complex tumor cases, the simulation using surgical instruments, and medical and family education. The materials, 3D printing techniques and costs to be used depend on the application.

CONCLUSION

This technology can be applied in clinical practice with a wide spectrum, using various tools and a range of available 3D printing methods. Incorporating 3D printing into an effective application can be a gratifying process with the use of a multidisciplinary team and rapid advances, so more experience would be needed with this technique to show a clinical gain.

Utility of Three-Dimensional Printing for Preoperative Assessment of Children with Extra-Cranial Solid Tumors: A Systematic Review

BACKGROUND

In cases with solid tumors, preoperative radiological investigations provide valuable information on the anatomy of the tumor and the adjoining structures, thus helping in operative planning. However, due to a two-dimensional view in these investigations, a detailed spatial relationship is difficult to decipher. In contrast, three-dimensional (3D) printing technology provides a precise topographic view to perform safe surgical resections of these tumors. This systematic review aimed to summarize and analyze current evidence on the utility of 3D printing in pediatric extra-cranial solid tumors.

METHODS

The present study was registered on PROSPERO-international prospective register of systematic reviews (registration number: CRD42020206022). PubMed, Embase, SCOPUS, and Google Scholar databases were explored with appropriate search criteria to select the relevant studies. Data were extracted to study the bibliographic information of each article, the number of patients in each study, age of the patient(s), type of tumor, organ of involvement, application of 3D printing (surgical planning, training, and/or parental education). The details of 3D printing, such as type of imaging used, software details, printing technique, printing material, and cost were also synthesized.

RESULTS

Eight studies were finally included in the systematic review. Three-dimensional printing technology was used in thirty children with Wilms tumor (n = 13), neuroblastoma (n = 7), hepatic tumors (n = 8), retroperitoneal tumor (n = 1), and synovial sarcoma (n = 1). Among the included studies, the technology was utilized for preoperative surgical planning (five studies), improved understanding of the surgical anatomy of solid organs (two studies), and improving the parental understanding of the tumor and its management (one study). Computed tomography and magnetic resonance imaging were either performed alone or in combination for radiological evaluation in these children. Different types of printers and printing materials were used in the included studies. The cost of the 3D printed models and time involved (range 10 h to 4-5 days) were reported by two studies each.

CONCLUSIONS

3D printed models can be of great assistance to pediatric surgeons in understanding the spatial relationships of tumors with the adjacent anatomic structures. They also facilitate the understanding of families, improving doctor-patient communication.

Three-Dimensional Printing for Cancer Applications: Research Landscape and Technologies

As a variety of novel technologies, 3D printing has been considerably applied in the field of health care, including cancer treatment. With its fast prototyping nature, 3D printing could transform basic oncology discoveries to clinical use quickly, speed up and even revolutionise the whole drug discovery and development process. This literature review provides insight into the up-to-date applications of 3D printing on cancer research and treatment, from fundamental research and drug discovery to drug development and clinical applications. These include 3D printing of anticancer pharmaceutics, 3D-bioprinted cancer cell models and customised nonbiological medical devices. Finally, the challenges of 3D printing for cancer applications are elaborated, and the future of 3D-printed medical applications is envisioned.

3D imaging technologies in minimally-invasive kidney and prostate cancer surgery: which is the urologists' perception?

BACKGROUND

Many specific 3D imaging technologies are currently available for the practising urologists. Aim of the study was to assess their perception about different 3D imaging tools in the field of prostate and kidney cancer surgery.

METHODS

All the attendees of the 8th Techno-Urology-Meeting were asked to fill a questionnaire regarding the role of 3D virtual reconstruction PDFs, 3D printing models, Augmented-Reality (AR) and mixed reality technology in the setting of surgical planning, patient counselling, intraoperative guidance and training for kidney and prostate cancer surgery; Moreover the different materials used for 3D printing were compared to assess the most suitable in reproducing the organ and tumor features, as well as their estimated cost and production time.

RESULTS

The population consisted of 180 attendees. Overall, AR was the preferred option for intraoperative guidance and training, in both prostate (55% and 38.3%) and kidney cancer surgery (58.3% and 40%). HoloLens was perceived as the best imaging technology for the surgical planning (50% for prostate and 60% for kidney), whereas printed models for patients counselling (66.7% for prostate and 61.7% for kidney). Fused deposition models were deemed as the best printing technology in representing kidney anatomy and renal tumor location (40%), while silicon (46.7%) and Polyjet (36.7%) models for prostate anatomy and cancer location. Finally, attendees demonstrated poor knowledge of 3D printing costs and production times.

CONCLUSIONS

Our study shows the perceptions of a heterogeneous surrogate of practising urologists about the role and potential applications of 3D imaging technologies in daily surgical practice.

Application of 3D printed model for planning the endoscopic endonasal transsphenoidal surgery

The application of 3D printing in planning endoscopic endonasal transsphenoidal surgery is illustrated based on the analysis of patients with intracranial skull base diseases who received treatment in our department. Cranial computed tomography/magnetic resonance imaging data are attained preoperatively, and three-dimensional reconstruction is performed using MIMICS (Materialise, Leuven, Belgium). Models of intracranial skull base diseases are printed using a 3D printer before surgery. The models clearly demonstrate the morphologies of the intracranial skull base diseases and the spatial relationship with adjacent large vessels and bones. The printing time of each model is 12.52–15.32 h, and the cost ranges from 900 to 1500 RMB. The operative approach was planned in vitro, and patients recovered postoperatively well without severe complications or death. In a questionnaire about the application of 3D printing, experienced neurosurgeons achieved scores of 7.8–8.8 out of 10, while unexperienced neurosurgeons achieved scores of 9.2–9.8. Resection of intracranial skull base lesions is demonstrated to be well assisted by 3D printing technique, which has great potential in disclosing adjacent anatomical relationships and providing the required help to clinical doctors in preoperative planning.

Three-dimensional printing in medicine: a systematic review of pediatric applications

BACKGROUND

Three-dimensional printing (3DP) addresses distinct clinical challenges in pediatric care including: congenital variants, compact anatomy, high procedural risk, and growth over time. We hypothesized that patient-specific applications of 3DP in pediatrics could be categorized into concise, discrete categories of use.

METHODS

Terms related to "three-dimensional printing" and "pediatrics" were searched on PubMed, Scopus, Ovid MEDLINE, Cochrane CENTRAL, and Web of Science. Initial search yielded 2122 unique articles; 139 articles characterizing 508 patients met full inclusion criteria.

RESULTS

Four categories of patient-specific 3DP applications were identified: Teaching of families and medical staff (9.3%); Developing intervention strategies (33.9%); Procedural applications, including subtypes: contour models, guides, splints, and implants (43.0%); and Material manufacturing of shaping devices or prosthetics (14.0%). Procedural comparative studies found 3DP devices to be equivalent or better than conventional methods, with less operating time and fewer complications.

CONCLUSION

Patient-specific applications of Three-Dimensional Printing in Medicine can be elegantly classified into four major categories: Teaching, Developing, Procedures, and Materials, sharing the same TDPM acronym. Understanding this schema is important because it promotes further innovation and increased implementation of these devices to improve pediatric care.

IMPACT

This article classifies the pediatric applications of patient-specific three-dimensional printing. This is a first comprehensive review of patient-specific three-dimensional printing in both pediatric medical and surgical disciplines, incorporating previously described classification schema to create one unifying paradigm. Understanding these applications is important since three-dimensional printing addresses challenges that are uniquely pediatric including compact anatomy, unique congenital variants, greater procedural risk, and growth over time. We identified four classifications of patient-specific use: teaching, developing, procedural, and material uses. By classifying these applications, this review promotes understanding and incorporation of this expanding technology to improve the pediatric care.

3D-printed models and virtual reality as new tools for image-guided robot-assisted nephron-sparing surgery: a systematic review of the newest evidences

PURPOSE OF REVIEW

Nowadays, kidney cancer surgery has been focusing on a patient-tailored management, expanding the indication to nephron-sparing surgery (NSS). Starting from computer tomography images, 3D models can be created, allowing a never experienced before understanding of surgical anatomy. Once obtained the models can be printed or virtually visualized with the aid to assist the surgeon in preoperative planning and simulation or intraoperative navigation. The aim of this systematic review is to assess the preoperative and intraoperative impact of 3D printed and virtual imaging for robotic NSS.

RECENT FINDINGS

Ten articles were found to meet the inclusion criteria and reviewed. An 'intermediate' score was assessed to the overall articles' quality. A moderate/high risk of bias was recorded for all the studies.

SUMMARY

3D-printed models were considered to be more useful during both preoperative simulations and patients' counseling. These models guaranteed a better comprehension of anatomical structures and surgical procedure. Costs and quality of the materials available represent the two main limits of this developing technology.Instead, in a virtual reality setting the preoperative planning was enhanced by using 3D virtual models in a mixed reality environment. Intraoperatively, the possibility to overlap the 3D model to real anatomy allowed augmented reality procedures. This technology is still a 'newborn' and is constantly evolving, expanding day by day the range of its potential applications.

[3d-technologies in hepatobiliary surgery]

The authors describe modern 3D technologies in hepatobiliary surgery. These approaches reduce the risk of intra- and postoperative complications. Virtual 3D reconstruction with clear visualization of parasitic cyst, adjacent vessels and bile ducts is valuable to create 3D-model of liver. This model may be applied for personalized laparoscopic approach and precise surgical intervention.

Challenges of training in adrenal surgery

While adrenal tumors are common, adrenalectomy is rather uncommon. This is one reason for the many challenges regarding the training of adrenal surgery. Here we focus on issues that are most pertinent regarding training of the young surgeons performing adrenalectomy. Due to the very limited literature, what is presented is mainly based on personal experience and/or from the literature published for other surgical operations and subspecialties. The discussed challenges include indications for surgery, surgical approaches and extent, and intraoperative complications. With advances in adrenal surgery, we expect some old challenges to be resolved, and some new challenges to arise. These challenges will be faced in order to continue to help our younger trainee acquire the knowledge and skills to best care for our patients with adrenal diseases.

Challenges in creating dissectible anatomical 3D prints for surgical teaching

Three-dimensional (3D) printing, or additive manufacturing, is now a widely used tool in pre-operative planning, surgical teaching and simulator training. However, 3D printing technology that produces models with accurate haptic feedback, biomechanics and visuals for the training surgeon is not currently available. Challenges and opportunities in creating such surgical models will be discussed in this review paper. Surgery requires proper tissue handling as well as knowledge of relevant anatomy. To prepare doctors properly, training models need to take into account the biomechanical properties of the anatomical structures that will be manipulated in any given operation. This review summarises and evaluates the current biomechanical literature as it relates to human tissues and correlates the impact of this knowledge on developing high fidelity 3D printed surgical training models. We conclude that, currently, a printer technology has not yet been developed which can replicate many of the critical qualities of human tissue. Advances in 3D printing technology will be required to allow the printing of multi-material products to achieve the mechanical properties required.

Three-Dimensional Printed Model and Virtual Reconstruction: An Extra Tool for Pediatric Solid Tumors Surgery

Introduction  Three-dimensional (3D) technology is increasingly applied for planning challenging surgical interventions. We report our experience using 3D printing and virtual reconstruction for surgical planning of complex tumor resections in children.

Methods  Data were obtained from preoperative magnetic resonance. imaging analysis and 3D virtual recreations were performed using specialized computer software. 3D real-scale geometry models, including tumor, adjacent organs, and relevant vascularization, were printed in colorimetric scale and different materials for optimal structures discrimination.

Results  Four complex cases were selected. The first case was a bilateral Wilms tumor. The volumetric reconstruction proved the presence of enough healthy renal tissue, allowing bilateral nephron-sparing surgery. In the second case, reconstruction contributed to the location of pulmonary metastases. The third case was an abdominal neuroblastoma stage L2. The 3D model was of high value for planning and as a reference during the intervention. The last case is a cervico-thoracic neuroblastoma with an anatomopathological diagnosis of ganglioneuroma, located at the cervico-mediastinal juncture, in close relationship with the cervical vessels.

Conclusions  3D reconstruction and the full-scale printing models are a useful tool in cases of complex tumor resections as they contribute to a better understanding of the relationships between the tumor and adjacent organs, helping to anticipate certain surgical complications. They also provide additional information to conventional imaging tests, being able to influence therapeutic decisions and facilitate the understanding by the family, improving doctor–patient communication.

The Utility of Muscle-Sparing Axillar Skin Crease Incision with Thoracoscopic Surgery in Children

BACKGROUND

Thoracoscopic surgery for pediatric benign tumors is a common procedure. However, a large incision is needed to remove large tumors from the thoracic cavity. And, for intrapulmonary sequestration in lower lobe, it sometimes needs a large incision to ligate the aberrant vessels. A muscle-sparing axillar skin crease incision (MSASCI) has been introduced for thoracic open surgery, resulting in excellent aesthetic outcomes compared with a standard incision. We herein report the utility of this MSASCI technique in thoracoscopic surgery to remove large tumors from the thoracic cavity and to ligate the aberrant vessels in intrapulmonary sequestration in lower lobe.

MATERIALS AND METHODS

From 2014 April to 2016 March, we performed the MSASCI technique in thoracoscopic surgeries for 5 children.

RESULT

Five cases were diagnosed as mediastinal masses (mature teratoma for 1 case, ganglioneuroblastoma for 2 cases, and extrapulmonary sequestration and intrapulmonary sequestration for 1 case each). The age at surgery was 32.0 ± 25.0 months (range 5-58 months). The size of the mediastinal mass was 9 × 5 × 5 cm, 4 × 3 × 3 cm, 5 × 5 × 2.5 cm, and 3 × 2.5 × 2 cm. For 4 other cases, except for the intrapulmonary sequestration case, the mass was resected under thoracoscopic surgery using only three or four 5-mm trocars and the mass was removed from the thoracic cavity using the MSASCI technique. For the intrapulmonary sequestration case, the aberrant vessels were resected under thoracoscopic surgery using only two 5-mm and one 12-mm trocars and the left lower lobectomy was performed using the MSASCI technique. All lesions were resected completely. No cases had surgical complications, none showed recurrence, and all cases demonstrated good cosmetic outcomes.

CONCLUSIONS

Performing thoracoscopic surgery using a MSASCI technique is associated with good cosmetic outcome.

Application of Three-Dimensional Visualization Technology in Laparoscopic Surgery for Pheochromocytoma/Paraganglioma: A Single-Center Experience

OBJECTIVE

To compare the feasibility of three-dimensional visualization technology (3DVT) with that of routine computed tomography (CT) examination during planning of laparoscopic surgery for pheochromocytoma (PHEO) and paraganglioma (PGL) and the effects on operative and postoperative outcomes.

PATIENTS AND METHODS

The clinical data for 36 patients who underwent laparoscopic surgery for PHEO/PGL in our department from January 2016 to April 2017 were analyzed retrospectively. Fourteen patients underwent laparoscopic surgery for PHEO/PGL after preoperative 3DVT-based assessment and 22 after conventional CT examination. The demographic parameters, surgical procedures used, and perioperative outcomes were compared between the two groups. Data were entered into a Microsoft Excel worksheet and analyzed using SPSS version 24.0.

RESULTS

No significant differences were found between the groups with regard to age, gender, body mass index, tumor size, surgical approach, estimated blood loss, mean length of hospital stay, number of hypertensive and hypotensive episodes during surgery, peak blood pressure (BP) values during tumor handling, and minimum values after tumor excision. However, the operating time was significantly shorter and the fluctuations in BP were significantly lower in the 3DVT group.

CONCLUSIONS

3DVT is a feasible and useful preoperative assessment method in patients undergoing laparoscopic surgery for PHEO/PGL. This imaging technique accurately shows the relationship between the tumor and peripheral structures and aids the surgeon's understanding of the anatomic structure in the operative area and in surgical planning.

Evaluation of a large adrenal carcinoma with 3D reconstruction of computed tomography images: A case report and literature review

Adrenocortical carcinoma (ACC) is an extremely rare disease caused by a cancerous growth in the adrenal cortex. Although most of adrenal tumors are benign, the functional ACC is malignant resulting in endocrine dysfunction and necessitates surgical removal. Retroperitoneal laparoscope adrenalectomy is often used to perform adrenal gland surgery. Here, we reported a case of huge ACC with the size of 6.8 cm × 5.2 cm. To achieve better surgical outcome, we integrated 3D reconstructed CT images into a dynamic video for preoperative planning and intraoperative guiding to resect the diseased adrenal gland completely without neighbor organ's injury and surgery complications. Moreover, we reviewed associated applications using 3D reconstructed CT imaging in surgery field. Finally, the evaluation and effect of such technology were discussed to reveal that the 3D dynamic video can help surgeon to make better preoperative assessment so as to give patients better therapy.

Simulation for endocrine surgery training: a call to action

The approach to surgical education has undergone metamorphosis in the last two decades. The mantra, ‘see one, do one, teach one’ has been replaced colloquially with ‘see one, simulate many deliberately, do one’. Simulation has become an integral part of surgical training across many specialties. A large amount of resources, time and expertise have been devoted to the development and study of simulation's role for surgical mastery and improved patient outcomes. Despite significant advances, there is still much to be learned. Many specialties, such as endocrine surgery, are yet to contribute to this effort. Herein, we assess the state of simulation in endocrine surgery and call for experts in the field to unite and join the simulation movement.