A quick guide for doctors - Part 2: 3D printing applications by speciality
Compilation of images of real cases in multiple specialties with 3D biomodels from MIRAI 3D
This article is a follow-up to Quick Guide for Physicians - Part 1: 3D Printing Applications by Specialty. Both publications aim to simplify surgeons' and clinicians' understanding of when it is valuable to implement 3D modelling and additive manufacturing technologies to better treat the patient.
5. Hepato-Bilio-Pancreatic Surgery
HPB is one of the fields where the least scientific evidence is found when talking about 3D technologies in surgery. However, the high vascularisation of these organs leads us to assume that the use of 3D models to guide procedures in oncological pathologies can be very interesting.
Recently, the RSNA (Radiological Society of North America) extended its original study on the usefulness of 3D printing in different areas, including HPB:
As a result of the study, it was found that 3D models are most useful in surgical resections of liver tumours, being very important to understand the exact location of the masses and their relationship to the main veins, arteries and bile ducts.
3D models can also be useful for determining optimal resection planes and predicting the risk of liver failure after surgery.
Another interesting application is their use to assess liver transplantation feasibility. This study (Zein et al. 2013) from the Cleveland Clinic generated anatomical models of the donor and recipient for three liver transplants, improving the spatial understanding between the different anatomical structures and minimising the possibility of complications.
The use of 3D for the delineation of pancreatic tumours has also proven to be important in the study of RSNA.
6. Colorectal Surgery
It tends to be thought that due to the flexibility of the intestine, the rigidity of most 3D printing materials is a limiting factor for the applicability of this technology in colorectal surgery. However, with the advancement of laparoscopic and robotic techniques, additive manufacturing together with 3D modelling has become a great ally for specific procedures such as right hemicolectomy.
In these cases, in a study of 61 patients, a very significant reduction in intraoperative time and bleeding has been demonstrated with the use of physical and virtual 3D biomodels (Chen et al. 2020).
7. Vascular Surgery
The main pathologies in vascular surgery where it is interesting to use 3D models when there are very particular anatomies are:
Aneurysms and aortic dissections
Valvulopathies and coronary artery disease
Congenital heart disease in adults
3D vascular models are frequently used for the customised design of stents, catheterisation training, planning of left atrial appendage closure and the choice of the most appropriate valve size, among others.
The study "Three-dimensional virtual and printed models for planning adult cardiovascular surgery" led by Dr. Raúl Boracci and Mariano Ferreira from the German Hospital of Buenos Aires, was recently published, where in team with MIRAI 3D, we made 14 models of heart and/or great vessels. The conclusion was that 3D printing provides valuable visual and tactile information, being a superior tool to conventional imaging studies.
8. Plastic Surgery
In reconstructive plastic surgery, the ability to combine 3D scanning with 3D printing makes it possible to generate guides and/or masks to reconstruct areas with high aesthetic impact, such as the face and breasts.
Dr Hernán Aguilar, together with Dr Horacio F. Mayer, from the Hospital Italiano de Buenos Aires, applied this low-cost 3D mask to reconstruct the face of a burned patient, shortening recovery times and optimising aesthetic and clinical results (Aguilar et al. 2019).
In breast reconstruction surgery, 3D facilitates the modelling of the abdominal dermoadipose flap in volume, shape and orientation.
This makes it possible to increase the precision of the reconstruction and the symmetry between breasts in a single surgery, avoiding having to perform subsequent interventions to retouch both the healthy breast and the reconstructed breast, a very common situation in this field (Mayer et al. 2020).
Why is this important, and even more so in 2021?
Firstly, to achieve sustainable health systems. Technology in itself, by definition, is neither good nor bad. Depending on how we use it in medicine: it can mean increased quality of care and productivity, or operational inefficiency and increased costs. Let's look at two examples:
Not very valuable use: A traumatologist has to operate on an anterior cruciate ligament by arthroscopy. By a "new innovative protocol" of the hospital, the radiology team gives the surgeon a 3D model of the patient's knee; as all surgeries are now planned with this technology. Our traumatologist has already operated on more than 100 patients with similar pathologies, and this particular patient does not present any special anatomical alterations. In this case, the better communication to the patient of how his procedure will be thanks to the 3D explanation, is overshadowed by a higher cost of surgery and a null impact of the biomodel in the planning and execution of the surgical act. No improvement is generated.
Valuable (and sustainable) use: A paediatric cardiovascular surgeon must decide on treatment for an infant with pulmonary atresia and ventricular septal defect. It is unclear whether surgery will be feasible, whether it is the best option for the child's development, and also what the optimal surgical plan is. With the 3D biomodel of the patient's specific anatomy, the discussion within the surgical team is simplified, as well as the explanation to the family about the treatment to be performed, and the procedure is optimised, achieving a reduction of 29 minutes in the operating room. In this case, the reduction of risks due to a better anatomical understanding and the impact on the patient's quality of life justify the investment, which in turn will be amortised by the reduction of the total surgery time and the long-term savings of hospitalisations that will no longer exist.
Secondly, all of the above is important for another reason, to recover faster and better from the COVID-19 pandemic.
In Europe alone, an estimated 5,000,000 people have had their treatment postponed because of the health situation. A recent McKinsey report indicates that in England, over the next 12 months, there will be an additional 18,000 deaths from cancer pathologies in addition to the annual average, as a result of late detection and treatment.
It is essential that healthcare institutions incorporate new technologies, including 3D printing, to make up for lost time and reduce waiting lists. 3D technologies will be a fundamental tool for shortening patient recovery times and optimising the productivity of operating rooms by reducing the duration of surgeries and preventing errors as a result of better pre-operative planning.
Finally... If you want to test this technology with a real case, I invite you to send us the patient's .DICOM images, anonymised, through the following link: https://mirai3d.wetransfer.com/
Thank you very much, what did you think about this information?
Matías Ezequiel Biancucci | Tel. +54911 3465 3913 | firstname.lastname@example.org