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Wang X, Mu M, Yan J, Han B, Ye R, Guo G. 3D printing materials and 3D printed surgical devices in oral and maxillofacial surgery: design, workflow and effectiveness. Regen Biomater 2024; 11:rbae066. [PMID: 39169972 PMCID: PMC11338467 DOI: 10.1093/rb/rbae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/14/2024] [Accepted: 06/02/2024] [Indexed: 08/23/2024] Open
Abstract
Oral and maxillofacial surgery is a specialized surgical field devoted to diagnosing and managing conditions affecting the oral cavity, jaws, face and related structures. In recent years, the integration of 3D printing technology has revolutionized this field, offering a range of innovative surgical devices such as patient-specific implants, surgical guides, splints, bone models and regenerative scaffolds. In this comprehensive review, we primarily focus on examining the utility of 3D-printed surgical devices in the context of oral and maxillofacial surgery and evaluating their efficiency. Initially, we provide an insightful overview of commonly utilized 3D-printed surgical devices, discussing their innovations and clinical applications. Recognizing the pivotal role of materials, we give consideration to suitable biomaterials and printing technology of each device, while also introducing the emerging fields of regenerative scaffolds and bioprinting. Furthermore, we delve into the transformative impact of 3D-printed surgical devices within specific subdivisions of oral and maxillofacial surgery, placing particular emphasis on their rejuvenating effects in bone reconstruction, orthognathic surgery, temporomandibular joint treatment and other applications. Additionally, we elucidate how the integration of 3D printing technology has reshaped clinical workflows and influenced treatment outcomes in oral and maxillofacial surgery, providing updates on advancements in ensuring accuracy and cost-effectiveness in 3D printing-based procedures.
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Affiliation(s)
- Xiaoxiao Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
- Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Min Mu
- Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiazhen Yan
- School of Mechanical Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Bo Han
- School of Pharmacy, Shihezi University, and Key Laboratory of Xinjiang Phytomedicine Resource and Utilization, Ministry of Education, Shihezi, 832002, China, Shihezi 832002, China
| | - Rui Ye
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Gang Guo
- Department of Biotherapy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Ang AJY, Chee SP, Tang JZE, Chan CY, Tan VYJ, Lee JA, Schrepfer T, Ahamed NMN, Tan MB. Developing a production workflow for 3D-printed temporal bone surgical simulators. 3D Print Med 2024; 10:16. [PMID: 38814431 PMCID: PMC11138071 DOI: 10.1186/s41205-024-00218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION 3D-printed temporal bone models enable the training and rehearsal of complex otological procedures. To date, there has been no consolidation of the literature regarding the developmental process of 3D-printed temporal bone models. A brief review of the current literature shows that many of the key surgical landmarks of the temporal bone are poorly represented in models. This study aims to propose a novel design and production workflow to produce high-fidelity 3D-printed temporal bone models for surgical simulation. METHODS Developmental phases for data extraction, 3D segmentation and Computer Aided Design (CAD), and fabrication are outlined. The design and fabrication considerations for key anatomical regions, such as the mastoid air cells and course of the facial nerve, are expounded on with the associated strategy and design methods employed. To validate the model, radiological measurements were compared and a senior otolaryngologist performed various surgical procedures on the model. RESULTS Measurements between the original scans and scans of the model demonstrate sub-millimetre accuracy of the model. Assessment by the senior otologist found that the model was satisfactory in simulating multiple surgical procedures. CONCLUSION This study offers a systematic method for creating accurate 3D-printed temporal bone models for surgical training. Results show high accuracy and effectiveness in simulating surgical procedures, promising improved training and patient outcomes.
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Affiliation(s)
| | - Shu Ping Chee
- 3D Printing Centre Singapore General Hospital, Singapore, Singapore
| | - Joyce Zhi En Tang
- Department of Otorhinolaryngology- Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ching Yee Chan
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Vanessa Yee Jueen Tan
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jordan Adele Lee
- Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia
| | - Thomas Schrepfer
- Department of Otolaryngology, University of Florida, Florida, USA
| | | | - Mark Bangwei Tan
- Department of Neuroradiology & 3D Printing Centre Singapore General Hospital, Singapore, Singapore
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Ali A, Morris JM, Decker SJ, Huang YH, Wake N, Rybicki FJ, Ballard DH. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: neurosurgical and otolaryngologic conditions. 3D Print Med 2023; 9:33. [PMID: 38008795 PMCID: PMC10680204 DOI: 10.1186/s41205-023-00192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG. CONCLUSIONS This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | | | - Summer J Decker
- Division of Imaging Research and Applied Anatomy, Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Yamaoka H, Sugawara T, Hirabayashi T, Wanibuchi M, Maehara T. A Three-Dimensional Anterior and Middle Cranial Fossa Model for Skull Base Surgical Training with Two Layers of the Colored Dura Mater. World Neurosurg 2023; 176:e575-e586. [PMID: 37270099 DOI: 10.1016/j.wneu.2023.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Adequate epidural procedures and anatomical knowledge are essential for the technical success of skull base surgery. We evaluated the usefulness of our three-dimensional (3D) model of the anterior and middle cranial fossa as a learning tool in improving knowledge of anatomy and surgical approaches, including skull base drilling and dura matter peeling techniques. METHODS Using a 3D printer, a bone model of the anterior and middle cranial fossa was created based on multi-detector row computed tomography data, incorporating artificial cranial nerves, blood vessels, and dura mater. The artificial dura mater was painted using different colors, with 2 pieces glued together to allow for the simulation of peeling the temporal dura propria from the lateral wall of the cavernous sinus. Two experts in skull base surgery and 1 trainee surgeon operated on this model and 12 expert skull base surgeons watched the operation video to evaluate this model subtlety on a scale of 1 to 5. RESULTS A total of 15 neurosurgeons, 14 of whom were skull base surgery expert, evaluated, scoring 4 or higher on most of the items. The experience of dural dissection and 3D positioning of important structures, including cranial nerves and blood vessels, was similar to that in actual surgery. CONCLUSIONS This model was designed to facilitate teaching anatomical knowledge and essential epidural procedure-related skills. It was shown to be useful for teaching essential elements of skull-base surgery.
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Affiliation(s)
- Hiroto Yamaoka
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Takashi Sugawara
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.
| | - Takumi Hirabayashi
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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Zhang Q, Zhou J, Zhi P, Liu L, Liu C, Fang A, Zhang Q. 3D printing method for bone tissue engineering scaffold. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2023; 17:None. [PMID: 36909661 PMCID: PMC9995276 DOI: 10.1016/j.medntd.2022.100205] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
3D printing technology is an emerging technology. It constructs solid bodies by stacking materials layer by layer, and can quickly and accurately prepare bone tissue engineering scaffolds with specific shapes and structures to meet the needs of different patients. The field of life sciences has received a great deal of attention. However, different 3D printing technologies and materials have their advantages and disadvantages, and there are limitations in clinical application. In this paper, the technology, materials and clinical applications of 3D printed bone tissue engineering scaffolds are reviewed, and the future development trends and challenges in this field are prospected.
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Affiliation(s)
- Qiliang Zhang
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Jian Zhou
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
| | - Peixuan Zhi
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
- The First Affiliated Hospital and Its National Resident Standardized Training Base, Dalian Medical University, Dalian, 116000, China
| | - Leixin Liu
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, 266071, China
- The First Affiliated Hospital and Its National Resident Standardized Training Base, Dalian Medical University, Dalian, 116000, China
| | - Chaozong Liu
- Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, London, United Kingdom
| | - Ao Fang
- Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, London, United Kingdom
- Department of Rehabilitation Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310003, China
- Corresponding author. Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, London, United Kingdom.
| | - Qidong Zhang
- Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, London, United Kingdom
- Beijing Advanced Innovation Centre for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing, 100191, China
- Corresponding author. Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, London, United Kingdom.
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Watanabe N, Watanabe K, Fujimura S, Karagiozov KL, Mori R, Ishii T, Murayama Y, Akasaki Y. Real Stiffness and Vividness Reproduction of Anatomic Structures Into the 3D Printed Models Contributes to Improved Simulation and Training in Skull Base Surgery. Oper Neurosurg (Hagerstown) 2023; 24:548-555. [PMID: 36786751 DOI: 10.1227/ons.0000000000000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/17/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Despite the advancement of 3-dimensional (3D) printing technology with medical application, its neurosurgical utility value has been limited to understanding the anatomy of bones, lesions, and their surroundings in the neurosurgical field. OBJECTIVE To develop a 3D printed model simulating the surgical technique applied in skull base surgery (SBS), especially to reproduce visually the surgical field together with the mechanical properties of tissues as perceived by the surgeon through procedures performance on a model. METHODS The Young modulus representing the degree of stiffness was measured for the tissues of anesthetized animals and printing materials. The stiffness and vividness of models were adjusted appropriately for each structure. Empty spaces were produced inside the models of brains, venous sinuses, and tumors. The 3D printed models were created in 7 cases of SBS planned patients and were used for surgical simulation. RESULTS The Young modulus of pig's brain ranged from 5.56 to 11.01 kPa and goat's brain from 4.51 to 13.69 kPa, and the dura of pig and goat values were 14.00 and 24.62 kPa, respectively. Although the softest printing material had about 20 times of Young modulus compared with animal brain, the hollow structure of brain model gave a soft sensation resembling the real organ and was helpful for bridging the gap between Young moduli values. A dura/tentorium-containing model was practical to simulate the real maneuverability at surgery. CONCLUSION The stiffness/vividness modulated 3D printed model provides an advanced realistic environment for training and simulation of a wide range of SBS procedures.
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Affiliation(s)
- Nobuyuki Watanabe
- Department of Neurosurgery, The Jikei University School of Medicine, Nishishinbashi, Tokyo, Japan
| | - Kentaro Watanabe
- Department of Neurosurgery, The Jikei University School of Medicine, Nishishinbashi, Tokyo, Japan
| | - Soichiro Fujimura
- Department of Mechanical Engineering, Tokyo University of Science, Niijuku, Tokyo, Japan.,Department of Innovation for Medical Information Technology, The Jikei University School of Medicine, Nishishinbashi, Tokyo, Japan
| | - Kostadin L Karagiozov
- Department of Neurosurgery, The Jikei University School of Medicine, Nishishinbashi, Tokyo, Japan
| | - Ryosuke Mori
- Department of Neurosurgery, The Jikei University School of Medicine, Nishishinbashi, Tokyo, Japan
| | - Takuya Ishii
- Department of Neurosurgery, The Jikei University School of Medicine, Nishishinbashi, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine, Nishishinbashi, Tokyo, Japan
| | - Yasuharu Akasaki
- Department of Neurosurgery, The Jikei University School of Medicine, Nishishinbashi, Tokyo, Japan
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Properties and Characteristics of Three-Dimensional Printed Head Models Used in Simulation of Neurosurgical Procedures: A Scoping Review. World Neurosurg 2021; 156:133-146.e6. [PMID: 34571242 DOI: 10.1016/j.wneu.2021.09.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intracranial surgery can be complex and high risk. Safety, ethical and financial factors make training in the area challenging. Head model 3-dimensional (3D) printing is a realistic training alternative to patient and traditional means of cadaver and animal model simulation. OBJECTIVE To describe important factors relating to the 3D printing of human head models and how such models perform as simulators. METHODS Searches were performed in PubMed, the Cochrane Library, Scopus, and Web of Science. Articles were screened independently by 3 reviewers using Covidence software. Data items were collected under 5 categories: study information; printers and processes; head model specifics; simulation and evaluations; and costs and production times. RESULTS Forty articles published over the last 10 years were included in the review. A range of printers, printing methods, and substrates were used to create head models and tissue types. Complexity of the models ranged from sections of single tissue type (e.g., bone) to high-fidelity integration of multiple tissue types. Some models incorporated disease (e.g., tumors and aneurysms) and artificial physiology (e.g., pulsatile circulation). Aneurysm clipping, bone drilling, craniotomy, endonasal surgery, and tumor resection were the most commonly practiced procedures. Evaluations completed by those using the models were generally favorable. CONCLUSIONS The findings of this review indicate that those who practice surgery and surgical techniques on 3D-printed head models deem them to be valuable assets in cranial surgery training. Understanding how surgical simulation on such models affects surgical performance and patient outcomes, and considering cost-effectiveness, are important future research endeavors.
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Aussedat C, Venail F, Marx M, Boullaud L, Bakhos D. Training in temporal bone drilling. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:140-145. [PMID: 33722469 DOI: 10.1016/j.anorl.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acquiring surgical experience in the operating room is increasingly difficult. Simulation of temporal bone drilling is therefore essential, and more and more widely used. The aim of this review is to clarify the limitations of classical surgical training, and to describe the different types of simulation available for temporal bone drilling. Systematic Medline search used the terms: "temporal bone" and training and surgery; "temporal bone" and training and drilling. Seventy-one of the 467 articles identified were relevant for this review. Various temporal bone simulators have been created to get around the limitations (ethical, financial, cultural, working time) of temporal bone drilling. They can be classified as cadaver, animal, physical or virtual models. The main advantages of physical and virtual prototyping are their ease of access, the possibility of repeating gestures on a standardised model, and the absence of ethical issues. Validation is essential before these simulators can be included in the curriculum, to ensure efficacy and thus improve patient safety in the operating room.
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Affiliation(s)
- C Aussedat
- Service ORL et chirurgie cervicofaciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
| | - F Venail
- Service ORL et chirurgie cervicofaciale, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - M Marx
- Service ORL et chirurgie cervicofaciale, CHU de Toulouse, place du Docteur-Baylac, 31059 Toulouse, France
| | - L Boullaud
- Service ORL et chirurgie cervicofaciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - D Bakhos
- Service ORL et chirurgie cervicofaciale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
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Frithioff A, Frendø M, Pedersen DB, Sørensen MS, Wuyts Andersen SA. 3D-Printed Models for Temporal Bone Surgical Training: A Systematic Review. Otolaryngol Head Neck Surg 2021; 165:617-625. [PMID: 33650897 DOI: 10.1177/0194599821993384] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE 3D-printed models hold great potential for temporal bone surgical training as a supplement to cadaveric dissection. Nevertheless, critical knowledge on manufacturing remains scattered, and little is known about whether use of these models improves surgical performance. This systematic review aims to explore (1) methods used for manufacturing and (2) how educational evidence supports using 3D-printed temporal bone models. DATA SOURCES PubMed, Embase, the Cochrane Library, and Web of Science. REVIEW METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were identified and data on manufacturing and validation and/or training extracted by 2 reviewers. Quality assessment was performed using the Medical Education Research Study Quality Instrument tool; educational outcomes were determined according to Kirkpatrick's model. RESULTS The search yielded 595 studies; 36 studies were found eligible and included for analysis. The described 3D-printed models were based on computed tomography scans from patients or cadavers. Processing included manual segmentation of key structures such as the facial nerve; postprocessing, for example, consisted of removal of print material inside the model. Overall, educational quality was low, and most studies evaluated their models using only expert and/or trainee opinion (ie, Kirkpatrick level 1). Most studies reported positive attitudes toward the models and their potential for training. CONCLUSION Manufacturing and use of 3D-printed temporal bones for surgical training are widely reported in the literature. However, evidence to support their use and knowledge about both manufacturing and the effects on subsequent surgical performance are currently lacking. Therefore, stronger educational evidence and manufacturing knowhow are needed for widespread implementation of 3D-printed temporal bones in surgical curricula.
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Affiliation(s)
- Andreas Frithioff
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
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Wang Y, Shi S, Zheng Q, Jin Y, Dai Y. Application of 3-dimensional printing technology combined with guide plates for thoracic spinal tuberculosis. Medicine (Baltimore) 2021; 100:e24636. [PMID: 33578582 PMCID: PMC7886418 DOI: 10.1097/md.0000000000024636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To explore the accuracy and security of 3-dimensional (3D) printing technology combined with guide plates in the preoperative planning of thoracic tuberculosis and the auxiliary placement of pedicle screws during the operation. METHODS Retrospective analysis was performed on the data of 60 cases of thoracic tuberculosis patients treated with 1-stage posterior debridement, bone graft fusion, and pedicle screw internal fixation in the Department of Orthopedics, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital from March 2017 to February 2019. There were 31 males and 29 females; age: 41 to 52 years old, with an average of (46.6 ± 2.0) years old. According to whether 3D printing personalized external guide plates are used or not, they are divided into 2 groups: 30 cases in 3D printing group (observation group), and 30 cases in pedicle screw placement group (control group). A 1:1 solid model of thoracic spinal tuberculosis and personalized pedicle guide plates was created using the 3D printing technology combined with guide plates in the observation group. Stability and accuracy tests were carried out in vitro and in vivo. 30 patients in the control group used conventional nail placement with bare hands. The amount of blood loss, the number of fluoroscopy, the operation time, and the occurrence of adverse reactions related to nail placement were recorded. After the operation, the patients were scanned by computed tomography to observe the screw position and grade the screw position to evaluate the accuracy of the navigation template. All patients were followed up for more than 1 year. Visual Analogue Scale scores, erythrocyte sedimentation rate, and C-reactive protein were evaluated before surgery, 6 months after surgery, and 12 months after surgery. RESULTS Sixty patients were followed up for 6 to 12 months after surgery. One hundred seventy-five and 177 screws were placed in the 3D printing group and the free-hand placement group, respectively. The rate of screw penetration was only 1.14% in the 3D-printed group (all 3 screws were grade 1) and 6.78% in the free-hand nail placement group (12 screws, 9 screws were grade 1 and 3 screws were grade 2). The difference was statistically significant (P = .047). The operation time of the 3D printing group ([137.67 ± 9.39] minutes), the cumulative number of intraoperative fluoroscopy ([4.67 ± 1.03] times), and the amount of intraoperative blood loss ([599.33 ± 83.37] mL) were significantly less than those in the manual nail placement group ([170.00 ± 20.48] minutes, [9.38 ± 1.76] times, [674.6 ± 83.61] mL). The differences were statistically significant (P < .05). There was no significant difference in VAS score and Oswestry disability index score between the 2 groups of patients before operation, 3 and 6 months after operation (P > .05). CONCLUSION The 3D printing technology combined with guide plate is used in thoracic spinal tuberculosis surgery to effectively reduce the amount of bleeding, shorten the operation time, and increase the safety and accuracy of nail placement.
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Charbonnier B, Hadida M, Marchat D. Additive manufacturing pertaining to bone: Hopes, reality and future challenges for clinical applications. Acta Biomater 2021; 121:1-28. [PMID: 33271354 DOI: 10.1016/j.actbio.2020.11.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/06/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
For the past 20 years, the democratization of additive manufacturing (AM) technologies has made many of us dream of: low cost, waste-free, and on-demand production of functional parts; fully customized tools; designs limited by imagination only, etc. As every patient is unique, the potential of AM for the medical field is thought to be considerable: AM would allow the division of dedicated patient-specific healthcare solutions entirely adapted to the patients' clinical needs. Pertinently, this review offers an extensive overview of bone-related clinical applications of AM and ongoing research trends, from 3D anatomical models for patient and student education to ephemeral structures supporting and promoting bone regeneration. Today, AM has undoubtably improved patient care and should facilitate many more improvements in the near future. However, despite extensive research, AM-based strategies for bone regeneration remain the only bone-related field without compelling clinical proof of concept to date. This may be due to a lack of understanding of the biological mechanisms guiding and promoting bone formation and due to the traditional top-down strategies devised to solve clinical issues. Indeed, the integrated holistic approach recommended for the design of regenerative systems (i.e., fixation systems and scaffolds) has remained at the conceptual state. Challenged by these issues, a slower but incremental research dynamic has occurred for the last few years, and recent progress suggests notable improvement in the years to come, with in view the development of safe, robust and standardized patient-specific clinical solutions for the regeneration of large bone defects.
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Meglioli M, Naveau A, Macaluso GM, Catros S. 3D printed bone models in oral and cranio-maxillofacial surgery: a systematic review. 3D Print Med 2020; 6:30. [PMID: 33079298 PMCID: PMC7574578 DOI: 10.1186/s41205-020-00082-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
AIM This systematic review aimed to evaluate the use of three-dimensional (3D) printed bone models for training, simulating and/or planning interventions in oral and cranio-maxillofacial surgery. MATERIALS AND METHODS A systematic search was conducted using PubMed® and SCOPUS® databases, up to March 10, 2019, by following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol. Study selection, quality assessment (modified Critical Appraisal Skills Program tool) and data extraction were performed by two independent reviewers. All original full papers written in English/French/Italian and dealing with the fabrication of 3D printed models of head bone structures, designed from 3D radiological data were included. Multiple parameters and data were investigated, such as author's purpose, data acquisition systems, printing technologies and materials, accuracy, haptic feedback, variations in treatment time, differences in clinical outcomes, costs, production time and cost-effectiveness. RESULTS Among the 1157 retrieved abstracts, only 69 met the inclusion criteria. 3D printed bone models were mainly used as training or simulation models for tumor removal, or bone reconstruction. Material jetting printers showed best performance but the highest cost. Stereolithographic, laser sintering and binder jetting printers allowed to create accurate models with adequate haptic feedback. The cheap fused deposition modeling printers exhibited satisfactory results for creating training models. CONCLUSION Patient-specific 3D printed models are known to be useful surgical and educational tools. Faced with the large diversity of software, printing technologies and materials, the clinical team should invest in a 3D printer specifically adapted to the final application.
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Affiliation(s)
- Matteo Meglioli
- University Center of Dentistry, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Adrien Naveau
- Department of Prosthodontics, Dental Science Faculty, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France.,Dental and Periodontal Rehabilitation Unit, Saint Andre Hospital, Bordeaux University Hospital, 46 rue Léo-Saignat, 33076, Bordeaux, France.,Biotis Laboratory, Inserm U1026, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France
| | - Guido Maria Macaluso
- University Center of Dentistry, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126, Parma, Italy.,IMEM-CNR, Parco Area delle Scienze 37/A, 43124, Parma, Italy
| | - Sylvain Catros
- Biotis Laboratory, Inserm U1026, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France. .,Department of Oral Surgery, UFR d'Odontologie, University of Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France. .,Service de Chirurgie Orale, CHU de Bordeaux, 46 rue Léo-Saignat, 33076, Bordeaux, France.
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Mooney MA, Cavallo C, Zhou JJ, Bohl MA, Belykh E, Gandhi S, McBryan S, Stevens SM, Lawton MT, Almefty KK, Nakaji P. Three-Dimensional Printed Models for Lateral Skull Base Surgical Training: Anatomy and Simulation of the Transtemporal Approaches. Oper Neurosurg (Hagerstown) 2020; 18:193-201. [PMID: 31172189 DOI: 10.1093/ons/opz120] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/21/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Three-dimensional (3D) printing holds great potential for lateral skull base surgical training; however, studies evaluating the use of 3D-printed models for simulating transtemporal approaches are lacking. OBJECTIVE To develop and evaluate a 3D-printed model that accurately represents the anatomic relationships, surgical corridor, and surgical working angles achieved with increasingly aggressive temporal bone resection in lateral skull base approaches. METHODS Cadaveric temporal bones underwent thin-slice computerized tomography, and key anatomic landmarks were segmented using 3D imaging software. Corresponding 3D-printed temporal bone models were created, and 4 stages of increasingly aggressive transtemporal approaches were performed (40 total approaches). The surgical exposure and working corridor were analyzed quantitatively, and measures of face validity, content validity, and construct validity in a cohort of 14 participants were assessed. RESULTS Stereotactic measurements of the surgical angle of approach to the mid-clivus, residual bone angle, and 3D-scanned infill volume demonstrated comparable changes in both the 3D temporal bone models and cadaveric specimens based on the increasing stages of transtemporal approaches (PANOVA <.003, <.007, and <.007, respectively), indicating accurate representation of the surgical corridor and working angles in the 3D-printed models. Participant assessment revealed high face validity, content validity, and construct validity. CONCLUSION The 3D-printed temporal bone models highlighting key anatomic structures accurately simulated 4 sequential stages of transtemporal approaches with high face validity, content validity, and construct validity. This strategy may provide a useful educational resource for temporal bone anatomy and training in lateral skull base approaches.
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Affiliation(s)
- Michael A Mooney
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Claudio Cavallo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - James J Zhou
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael A Bohl
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Evgenii Belykh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sirin Gandhi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sarah McBryan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Shawn M Stevens
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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14
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Ospina JC, Fandiño A, Hernández S, Uriza LF, Aragonéz D, Mondragón IF, Durán D, Magness J. 3D-printed pediatric temporal bone models for surgical training: a patient-specific and low-cost alternative. ACTA ACUST UNITED AC 2019. [DOI: 10.2217/3dp-2019-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To determine the usefulness of low-cost 3D-printed pediatric temporal bone models and to define if they could be used as a tool for large-scale surgical training based on their affordability. Materials & methods: Prototypes of a pediatric temporal bone were printed using fused deposition modeling 3D printing technique. The prototypes were drilled. The surgical simulation experience was registered by means of a Likert scale questionnaire. Results: The prototypes adequately simulated a cadaveric temporal bone. The costs associated with production were low compared with other commercial models making it a cost-effective alternative for a temporal bone laboratory. Conclusion: Printed temporal bones created by means of fused deposition modeling are useful for surgical simulation and training in otolaryngology, and it is possible to achieve detailed low-cost models.
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Affiliation(s)
- Juan C Ospina
- Otolaryngology & Maxillofacial Surgery Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Cra. 7 No. 40–62, 110231 Bogotá, Colombia
| | - Alejandro Fandiño
- Otolaryngology & Maxillofacial Surgery Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Cra. 7 No. 40–62, 110231 Bogotá, Colombia
| | - Santiago Hernández
- Otolaryngology & Maxillofacial Surgery Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Cra. 7 No. 40–62, 110231 Bogotá, Colombia
| | - Luis F Uriza
- Radiology Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Cra. 7 No. 40–62, 110231 Bogotá, Colombia
| | - Diego Aragonéz
- Technological Center of Industrial Automation (CTAI), Department of Engineering, Pontificia Universidad Javeriana, Cra. 7 No. 40–69, 110231 Bogotá, Colombia
| | - Iván F Mondragón
- Technological Center of Industrial Automation (CTAI), Department of Engineering, Pontificia Universidad Javeriana, Cra. 7 No. 40–69, 110231 Bogotá, Colombia
| | - Deivy Durán
- Technological Center of Industrial Automation (CTAI), Department of Engineering, Pontificia Universidad Javeriana, Cra. 7 No. 40–69, 110231 Bogotá, Colombia
| | - Jay Magness
- Radiology Department, San Ignacio University Hospital, Pontificia Universidad Javeriana, Cra. 7 No. 40–62, 110231 Bogotá, Colombia
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Kondo K, Nemoto M, Harada N, Masuda H, Ando S, Kubota S, Sugo N. Three-Dimensional Printed Model for Surgical Simulation of Combined Transpetrosal Approach. World Neurosurg 2019; 127:e609-e616. [DOI: 10.1016/j.wneu.2019.03.219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/26/2022]
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16
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Morone PJ, Shah KJ, Hendricks BK, Cohen-Gadol AA. Virtual, 3-Dimensional Temporal Bone Model and Its Educational Value for Neurosurgical Trainees. World Neurosurg 2018; 122:e1412-e1415. [PMID: 30471440 DOI: 10.1016/j.wneu.2018.11.074] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Learning complex neuroanatomy is an arduous yet important task for every neurosurgical trainee. As technology has advanced, various modalities have been created to aid our understanding of anatomy. This study sought to assess the educational value of a virtual, 3-dimensional (3D) temporal bone model. METHODS The 3D temporal bone model was created with assistance of computer graphic designers and published online. Its educational value as a teaching was tool was assessed by querying 73 neurosurgery residents at 4 institutions and was compared with that of a standard, 2-dimensional (2D) temporal bone resource. Data were collected via a survey, and significance among responses was analyzed via a univariate chi-square test. RESULTS The survey response rate was 37%. Greater than 90% of residents preferred to study with the 3D model compared with the 2D resource and felt that the 3D model allowed them understand the anatomy more realistically (P = 0.001). Moreover, >90% of residents believed that reviewing the 3D model before an actual surgery could lead to improved operative efficiency and safety (P = 0.001). CONCLUSIONS This study demonstrates the utility of a novel, 3D temporal bone model as a teaching tool for neurosurgery residents. The model contains accurate anatomic structures and allows user interaction via a virtual, immersive environment.
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Affiliation(s)
- Peter J Morone
- Vanderbilt University Medical Center, Department of Neurological Surgery, Nashville, Tennessee, USA
| | - Kushal J Shah
- University of Kansas Medical Center, Department of Neurosurgery, Kansas City, Kansas, USA
| | - Benjamin K Hendricks
- Barrow Neurological Institute, Department of Neurological Surgery, Phoenix, Arizona, USA
| | - Aaron A Cohen-Gadol
- Indiana University School of Medicine, Department of Neurological Surgery, Indianapolis, Indiana, USA.
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17
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Barber SR, Wong K, Kanumuri V, Kiringoda R, Kempfle J, Remenschneider AK, Kozin ED, Lee DJ. Augmented Reality, Surgical Navigation, and 3D Printing for Transcanal Endoscopic Approach to the Petrous Apex. OTO Open 2018; 2:2473974X18804492. [PMID: 30719506 PMCID: PMC6348519 DOI: 10.1177/2473974x18804492] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/04/2018] [Accepted: 09/12/2018] [Indexed: 11/26/2022] Open
Abstract
Otolaryngologists increasingly use patient-specific 3-dimensional (3D)–printed anatomic physical models for preoperative planning. However, few reports describe concomitant use with virtual models. Herein, we aim to (1) use a 3D-printed patient-specific physical model with lateral skull base navigation for preoperative planning, (2) review anatomy virtually via augmented reality (AR), and (3) compare physical and virtual models to intraoperative findings in a challenging case of a symptomatic petrous apex cyst. Computed tomography (CT) imaging was manually segmented to generate 3D models. AR facilitated virtual surgical planning. Navigation was then coupled to 3D-printed anatomy to simulate surgery using an endoscopic approach. Intraoperative findings were comparable to simulation. Virtual and physical models adequately addressed details of endoscopic surgery, including avoidance of critical structures. Complex lateral skull base cases may be optimized by surgical planning via 3D-printed simulation with navigation. Future studies will address whether simulation can improve patient outcomes.
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Affiliation(s)
- Samuel R Barber
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA.,Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Kevin Wong
- Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Vivek Kanumuri
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otology and Laryngology, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Ruwan Kiringoda
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otology and Laryngology, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Judith Kempfle
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otology and Laryngology, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Aaron K Remenschneider
- Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Elliott D Kozin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otology and Laryngology, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otology and Laryngology, Harvard Medical School, Cambridge, Massachusetts, USA
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18
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Pakzaban P. A 3-Dimensional-Printed Spine Localizer: Introducing the Concept of Online Dissemination of Novel Surgical Instruments. Neurospine 2018; 15:242-248. [PMID: 30126266 PMCID: PMC6226123 DOI: 10.14245/ns.1836068.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/16/2018] [Indexed: 11/21/2022] Open
Abstract
Background/Aims To date, applications of 3-dimensional (3D) printing in neurosurgery have been limited to the creation of anatomical models for training and simulation, fabrication of customized implants, and production of patient-specific surgical tool guides. We aim to demonstrate a new application of this technology for the online dissemination of novel surgical instrument designs across the world.
Methods A link to a 3D printing file and instructions for assembly of a spine localizer are included in this article. This device was used to determine the optimal location of skin incision in lumbar microsurgery in 43 consecutive patients. Data regarding the accuracy of the surgeon's initial estimate of the target site based on palpation of anatomical landmarks and the accuracy of the localizer device in locating the target spine segment were prospectively collected.
Results In 35 cases (81%), the surgeon’s initial estimate of the target site was correct. In the remaining 8 cases (19%), the initial estimate was off by 1 motion segment. Inaccuracy of the surgeon’s estimate was found to be associated with a higher body mass index and the presence of transitional lumbosacral anatomy, but not with age, sex, or location of the target segment. In all patients, the location of the incision guided by the localizer was found to overlie the target segment, yielding a device accuracy of 100%. There was no need to extend the incision or modify the surgical trajectory.
Conclusion This 3D-printable localizer serves as an example of a device that can be disseminated online and printed at the point of use, thus promoting online tool-sharing by neurosurgeons.
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Werz SM, Zeichner SJ, Berg BI, Zeilhofer HF, Thieringer F. 3D Printed Surgical Simulation Models as educational tool by maxillofacial surgeons. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2018; 22:e500-e505. [PMID: 29479802 DOI: 10.1111/eje.12332] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate whether inexpensive 3D models can be suitable to train surgical skills to dental students or oral and maxillofacial surgery residents. Furthermore, we wanted to know which of the most common filament materials, acrylonitrile butadiene styrene (ABS) or polylactic acid (PLA), can better simulate human bone according to surgeons' subjective perceptions. MATERIALS AND METHODS Upper and lower jaw models were produced with common 3D desktop printers, ABS and PLA filament and silicon rubber for soft tissue simulation. Those models were given to 10 blinded, experienced maxillofacial surgeons to perform sinus lift and wisdom teeth extraction. Evaluation was made using a questionnaire. RESULTS Because of slightly different density and filament prices, each silicon-covered model costs between 1.40-1.60 USD (ABS) and 1.80-2.00 USD (PLA) based on 2017 material costs. Ten experienced raters took part in the study. All raters deemed the models suitable for surgical education. No significant differences between ABS and PLA were found, with both having distinct advantages. CONCLUSION The study demonstrated that 3D printing with inexpensive printing filaments is a promising method for training oral and maxillofacial surgery residents or dental students in selected surgical procedures. With a simple and cost-efficient manufacturing process, models of actual patient cases can be produced on a small scale, simulating many kinds of surgical procedures.
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Affiliation(s)
- S M Werz
- Department of Head-, Neck- and Facial Plastic Surgery, Medius Klinik, Ostfildern-Ruit, Germany
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - S J Zeichner
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- OMF Radiology, Columbia University Medical Center, New York, NY, USA
| | - B-I Berg
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - H-F Zeilhofer
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - F Thieringer
- Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, Basel, Switzerland
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Lin QS, Lin YX, Wu XY, Yao PS, Chen P, Kang DZ. Utility of 3-Dimensional–Printed Models in Enhancing the Learning Curve of Surgery of Tuberculum Sellae Meningioma. World Neurosurg 2018; 113:e222-e231. [DOI: 10.1016/j.wneu.2018.01.215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/24/2022]
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Feldman H, Kamali P, Lin SJ, Halamka JD. Clinical 3D printing: A protected health information (PHI) and compliance perspective. Int J Med Inform 2018; 115:18-23. [PMID: 29779716 DOI: 10.1016/j.ijmedinf.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 03/15/2018] [Accepted: 04/12/2018] [Indexed: 12/17/2022]
Abstract
Advanced manufacturing techniques such as 3-dimensional (3D) printing, while mature in other industries, are starting to become more commonplace in clinical care. Clinicians are producing physical objects based on patient clinical data for use in planning care and educating patients, all of which should be managed like any other healthcare system data, except it exists in the "real" world. There are currently no provisions in the Health Insurance Portability and Accountability Act (HIPAA) either in its original 1996 form or in more recent updates that address the nature of physical representations of clinical data. We submit that if we define the source data as protected health information (PHI), then the objects 3D printed from that data need to be treated as both (PHI), and if used clinically, part of the clinical record, and propose some basic guidelines for quality and privacy like all documentation until regulatory frameworks can catch up to this technology. Many of the mechanisms designed in the paper and film chart era will work well with 3D printed patient data.
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Affiliation(s)
- Henry Feldman
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
| | - Parisa Kamali
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - John D Halamka
- Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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Affiliation(s)
- Masahiko Wanibuchi
- Department of Neurosurgery, Sapporo Medical University School of Medicine
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23
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European status on temporal bone training: a questionnaire study. Eur Arch Otorhinolaryngol 2017; 275:357-363. [PMID: 29185029 DOI: 10.1007/s00405-017-4824-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE In otorhinolaryngology training, introduction to temporal bone surgery through hands-on practice on cadaveric human temporal bones is the gold-standard training method before commencing supervised surgery. During the recent decades, the availability of such specimens and the necessary laboratory facilities for training seems to be decreasing. Alternatives to traditional training can consist of drilling artificial models made of plaster or plastic but also virtual reality (VR) simulation. Nevertheless, the integration and availability of these alternatives into specialist training programs remain unknown. METHODS We conducted a questionnaire study mapping current status on temporal bone training and included responses from 113 departments from 23 countries throughout Europe. RESULTS In general, temporal bone training during residency in ORL is organized as in-house training, or as participation in national or international temporal bone courses or some combination hereof. There are considerable differences in the availability of training facilities for temporal bone surgery and the number of drillings each ORL trainee can perform. Cadaveric dissection is still the most commonly used training modality. CONCLUSIONS VR simulation and artificial models are reported to be used at many leading training departments already. Decreasing availability of cadavers, lower costs of VR simulation and artificial models, in addition to established evidence for a positive effect on the trainees' competency, were reported as the main reasons. Most remaining departments expect to implement VR simulation and artificial models for temporal bone training into their residency programs in the near future.
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24
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3D printing for clinical application in otorhinolaryngology. Eur Arch Otorhinolaryngol 2017; 274:4079-4089. [DOI: 10.1007/s00405-017-4743-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/12/2017] [Indexed: 12/12/2022]
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Hoang D, Perrault D, Stevanovic M, Ghiassi A. Surgical applications of three-dimensional printing: a review of the current literature & how to get started. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:456. [PMID: 28090512 DOI: 10.21037/atm.2016.12.18] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Three dimensional (3D) printing involves a number of additive manufacturing techniques that are used to build structures from the ground up. This technology has been adapted to a wide range of surgical applications at an impressive rate. It has been used to print patient-specific anatomic models, implants, prosthetics, external fixators, splints, surgical instrumentation, and surgical cutting guides. The profound utility of this technology in surgery explains the exponential growth. It is important to learn how 3D printing has been used in surgery and how to potentially apply this technology. PubMed was searched for studies that addressed the clinical application of 3D printing in all surgical fields, yielding 442 results. Data was manually extracted from the 168 included studies. We found an exponential increase in studies addressing surgical applications for 3D printing since 2011, with the largest growth in craniofacial, oromaxillofacial, and cardiothoracic specialties. The pertinent considerations for getting started with 3D printing were identified and are discussed, including, software, printing techniques, printing materials, sterilization of printing materials, and cost and time requirements. Also, the diverse and increasing applications of 3D printing were recorded and are discussed. There is large array of potential applications for 3D printing. Decreasing cost and increasing ease of use are making this technology more available. Incorporating 3D printing into a surgical practice can be a rewarding process that yields impressive results.
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Affiliation(s)
- Don Hoang
- USC Plastic and Reconstructive Surgery, Los Angeles, CA, USA
| | - David Perrault
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Milan Stevanovic
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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