Jan Witowski, Mateusz Sitkowski, Michal Wysocki, MD, Zuzanna Malina, Piotr Malczak, MD, Piotr Major, MD, PhD, Michal Pedziwiatr, MD, PhD, Andrzej Budzynski, Prof, MD, PhD. 2nd Department of General Surgery, Jagiellonian University Medical College
Background/objectives: 3D printing has been shown to be a useful tool for preoperative planning in various surgical disciplines. However, there are only several single case reports in the field of liver surgery. This is because of problematic visualization of anatomy, difficulties in methodology and – most importantly – high costs limiting implementation of 3D printing. The goal of this study is to evaluate the utility of personalized 3D-printed liver models as routinely used tools in planning and guidance of laparoscopic liver resections.
Materials and methods: Contrast-enhanced computed tomography images of 6 consecutive patients who underwent laparoscopic liver resections in a single centre were acquired and processed. Proper segmentation algorithms were used to obtain virtual models of anatomical structures, including vessels, tumor, gallbladder and liver parenchyma in STL (stereolithography) format. After processing files, models in parts were subsequently printed with desktop Ultimaker 2+ (Ultimaker, Netherlands) 3D printer, using polylactic acid filaments as printing material. All parts were matched together to create a mold, which was later casted with transparent silicone. Models were delivered to surgical teams prior to the surgery as well as used in patients’ education.
Results: Up to now, six full-sized, transparent, personalized liver models were created before laparoscopic liver resections and used as a tool for preoperative planning and intraoperative guidance. Usefulness of these models has been evaluated qualitatively with surgeons. Operative data was obtained for each patient and it will be used for quantitative analysis in further study phases. Costs of one model varied between $100 and $150 and whole process of development took approximately 5 days in every case.
Conclusions: 3D-printed models allow precise planning in complex cases of minimally invasive liver surgery by providing high-quality visualization of patient-specific anatomy. Implementation of this technology might potentially lead to clinical benefits, such as reduction of operative time or improvement of short-term outcomes. Having said that, more data is needed to decisively prove these hypotheses.
Fig 1. Three different 3D-printed liver models. Visible: inferior vena cava and hepatic veins (blue), portal vein (pink), tumor (green).
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87901
Program Number: P507
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster