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Kelly SS, Suarez CA, Mirsky NA, Slavin BV, Brochu B, Vivekanand Nayak V, El Shatanofy M, Witek L, Thaller SR, Coelho PG. Application of 3D Printing in Cleft Lip and Palate Repair. J Craniofac Surg 2024:00001665-990000000-01572. [PMID: 38738906 DOI: 10.1097/scs.0000000000010294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/03/2024] [Indexed: 05/14/2024] Open
Abstract
This manuscript reviews the transformative impact of 3-dimensional (3D) printing technologies in the treatment and management of cleft lip and palate (CLP), highlighting its application across presurgical planning, surgical training, implantable scaffolds, and postoperative care. By integrating patient-specific data through computer-aided design and manufacturing, 3D printing offers tailored solutions that improve surgical outcomes, reduce operation times, and enhance patient care. The review synthesizes current research findings, technical advancements, and clinical applications, illustrating the potential of 3D printing to revolutionize CLP treatment. Further, it discusses the future directions of combining 3D printing with other innovative technologies like artificial intelligence, 4D printing, and in situ bioprinting for more comprehensive care strategies. This paper underscores the necessity for multidisciplinary collaboration and further research to overcome existing challenges and fully utilize the capabilities of 3D printing in CLP repair.
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Affiliation(s)
- Sophie S Kelly
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL
| | | | | | | | | | | | - Muhammad El Shatanofy
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL
| | - Lukasz Witek
- Biomaterials Division, NYU Dentistry
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York
- Department of Biomedical Engineering, Tandon School of Engineering, New York University, Brooklyn, NY
| | - Seth R Thaller
- DeWitt Daughtry Family, Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Paulo G Coelho
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine
- DeWitt Daughtry Family, Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
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Teuber Lobos C, Benitez BK, Lill Y, Kiser LE, Tache A, Fernandez-Pose M, Campolo Gonzalez A, Nalabothu P, Sharma N, Thieringer FM, Vargas Díaz A, Mueller AA. Cleft lip and palate surgery simulator: Open source simulation model. Heliyon 2024; 10:e29185. [PMID: 38638944 PMCID: PMC11024558 DOI: 10.1016/j.heliyon.2024.e29185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
Objective Cleft lip and palate is the most common craniofacial birth anomaly and requires surgery in the first year of life. However, craniofacial surgery training opportunities are limited. The aim of this study was to present and evaluate an open-source cleft lip and palate hybrid (casting and three-dimensional (3D) printing) simulation model which can be replicated at low cost to facilitate the teaching and training of cleft surgery anatomy and techniques. Design The soft tissue component of the cleft surgery training model was casted using a 3D printed 5-component mold and silicone. The bony structure was designed to simulate the facial anatomy and to hold the silicone soft tissue. Setting Two groups, one group of trainees and one group of expert surgeons, at University Hospital Basel in Switzerland and Pontifical Catholic University of Chile in Santiago, Chile, tested the cleft lip and palate simulation model. Participants completed a Likert-based face and content validity questionnaire to assess the realism of the model and its usefulness in surgical training. Results More than 70 % of the participants agreed that the model accurately simulated human tissues found in patients with unilateral cleft lip and palate. Over 60 % of the participants also agreed that the model realistically replicated surgical procedures. In addition, 80-90 % of the participants found the model to be a useful and appropriate tool for teaching the anatomy and surgical techniques involved in performing unilateral cleft lip and palate repair. Conclusion This open-source protocol provides a cost-effective solution for surgeons to introduce the cleft morphology and surgical techniques to trainees on a regular basis. It addresses the current financial barrier that limits access to commercially available models during the early stages of surgeon training prior to specialization in the field.
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Affiliation(s)
- Cristian Teuber Lobos
- Department of Surgical Oncology and Maxillofacial Surgery, Surgery Division, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Benito K. Benitez
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Yoriko Lill
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Laura E. Kiser
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Ana Tache
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Maria Fernandez-Pose
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Andres Campolo Gonzalez
- Department of Surgical Oncology and Maxillofacial Surgery, Surgery Division, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Prasad Nalabothu
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Neha Sharma
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Florian M. Thieringer
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Alex Vargas Díaz
- Department of Surgical Oncology and Maxillofacial Surgery, Surgery Division, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Andreas A. Mueller
- Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Martínez JJ, Galvez-Yanjari V, de la Fuente R, Kychenthal C, Kattan E, Bravo S, Munoz-Gama J, Sepúlveda M. Process-oriented metrics to provide feedback and assess the performance of students who are learning surgical procedures: The percutaneous dilatational tracheostomy case. MEDICAL TEACHER 2022; 44:1244-1252. [PMID: 35544751 DOI: 10.1080/0142159x.2022.2073209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Assessing competency in surgical procedures is key for instructors to distinguish whether a resident is qualified to perform them on patients. Currently, assessment techniques do not always focus on providing feedback about the order in which the activities need to be performed. In this research, using a Process Mining approach, process-oriented metrics are proposed to assess the training of residents in a Percutaneous Dilatational Tracheostomy (PDT) simulator, identifying the critical points in the execution of the surgical process. MATERIALS AND METHODS A reference process model of the procedure was defined, and video recordings of student training sessions in the PDT simulator were collected and tagged to generate event logs. Three process-oriented metrics were proposed to assess the performance of the residents in training. RESULTS Although the students were proficient in classic metrics, they did not reach the optimum in process-oriented metrics. Only in 25% of the stages the optimum was achieved in the last session. In these stages, the four more challenging activities were also identified, which account for 32% of the process-oriented metrics errors. CONCLUSIONS Process-oriented metrics offer a new perspective on surgical procedures performance, providing a more granular perspective, which enables a more specific and actionable feedback for both students and instructors.
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Affiliation(s)
- Juan José Martínez
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Víctor Galvez-Yanjari
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rene de la Fuente
- Department of Anaesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Kychenthal
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Bravo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Munoz-Gama
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcos Sepúlveda
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
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[Survey on training in orthopedics/trauma surgery : Is Germany ready for a competence-based training?]. Chirurg 2021; 93:586-595. [PMID: 34882255 DOI: 10.1007/s00104-021-01536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVE A high-quality advanced training is a key factor for good and safe patient treatment. Germany is currently revising the advanced training curricula and logbooks aiming to change the training into a competence-based training. The aim of this study was to analyze the day to day reality of orthopedic and trauma surgery advanced training in Germany based on the elements of the advanced training. METHODS In March 2020 an online survey on advanced training was carried out with 44 questions on the topics of advanced training curriculum, logbook, educational resources, evaluation, authorized trainer and distribution of working time . RESULTS A total of 237 persons completed the survey, of which 208 fulfilled the inclusion criteria. The respondents perceived a lack of clear standards in the advanced training curriculum and 25% did not receive structured learning resources in the form of simulations or courses. Mandatory annual process interviews were performed in only 58%. Most respondents valued the expertise of the trainers in orthopedic and trauma surgery, whereas they rated their competence in supervision and giving feedback as below average. Administrative work consumed 220 min of the daily working time and on average 60min remained per day for respondents to learn operative skills. CONCLUSION The survey revealed inconsistencies in the current advanced training curriculum and a lack of supervision and evaluation. The implementation of competence-based advanced training should therefore not only focus on a change of the curriculum but also on implementing competence-based training at all levels of training (learning resources, training, evaluation).
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Ludwig J, Jakobsen RB, Charles YP, Seifert J, Incoll I, Wood ML, Parmar D, Canter R. What it takes to become an orthopaedic surgeon: A comparison of orthopaedic surgical training programmes in 10 countries focusing on structure and fellowship requirements. Int J Surg 2021; 95:106150. [PMID: 34715383 DOI: 10.1016/j.ijsu.2021.106150] [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: 08/04/2021] [Revised: 09/28/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The quality of surgical training has been highlighted as one of the most important patient safety issues in the future. Training surgeons and supporting them to do their best should be considered integral in providing optimum and safe care for the individual patient and the best possible return on investment in training medical professionals. In 2011, an international consensus statement defined fundamental principles for surgical training. PURPOSE This study examines orthopaedic surgical training to explore the similarities and differences in the requirements for trainees to obtain board certification in ten countries. METHODS Countries of the Commonwealth Health Care Comparison: Canada, the United Kingdom, the United States of America, Australia, New Zealand, Germany, France, the Netherlands, Norway and Switzerland were chosen to be compared. The relevant information was extracted from official information from authorities and administrative bodies. RESULTS The study revealed significant differences in duration, organisation and assessment of training. So-called "competency-based" training is not featured in every country, and the manner of its implementation is variable. In particular, the numbers in surgical cases required to be accredited varies by country ranging from 1260 (UK) to 340 (Norway). CONCLUSION Despite the recommendation in 2011 for some degree of uniformity across surgical training in industrialised countries, evidence suggests wide variation in the training programmes which is likely to be a concern in both quality of training as well as present and future patient safety.
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Affiliation(s)
- Johanna Ludwig
- BG Klinikum, Unfallkrankenhaus Berlin, Germany Kellogg College, University of Oxford, Oxford, United Kingdom Department of orthopedic surgery, Department of Health Management and Health Economics, Akershus University hospital and Institute of Health and Society, University Oslo, OSLO, Norway Hôpitaux Universitaires de Strasbourg, Department of Spine Surgery, Faculté de Médecine, Université de Strasbourg, France Department of Traumatology, University medicine, Universitätsmedizin Greifswald, University Greifswald, Greifswald, Germany University of Newcastle, District Clinical Director of Surgery; Clinical Lead, Quality & Innovation - Central Coast Local Health District, Graduate Programs in Surgical Education -University of Melbourne, Australia Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
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Trainee-Trainer outcomes in Mastoid surgery: A comparative study. The Journal of Laryngology & Otology 2021; 136:293-296. [PMID: 34702379 DOI: 10.1017/s0022215121003285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sivakumar J, Crosthwaite G. Role of private practice in general surgical training in Australia. ANZ J Surg 2020; 90:2164-2165. [PMID: 33200520 DOI: 10.1111/ans.16243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan Sivakumar
- General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare Richmond, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gary Crosthwaite
- General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare Richmond, Melbourne, Victoria, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Bennett D, McMenamin P, Pacilli M, Clarnette T, Nataraja RM. Novel application of additive manufacturing techniques for paediatric choledochal malformations. J Paediatr Child Health 2018; 54:807-809. [PMID: 29603496 DOI: 10.1111/jpc.13909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel Bennett
- Department of Paediatric Surgery and Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Paul McMenamin
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery and Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Tom Clarnette
- Department of Paediatric Surgery and Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery and Surgical Simulation, Monash Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Post-operative Complications Following Emergency Operations Performed by Trainee Surgeons: A Retrospective Analysis of Surgical Deaths. World J Surg 2018; 42:2329-2338. [DOI: 10.1007/s00268-018-4465-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3D Printed Models of Cleft Palate Pathology for Surgical Education. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1029. [PMID: 27757345 PMCID: PMC5055011 DOI: 10.1097/gox.0000000000001029] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/13/2016] [Indexed: 12/14/2022]
Abstract
To explore the potential viability and limitations of 3D printed models of children with cleft palate deformity. BACKGROUND The advantages of 3D printed replicas of normal anatomical specimens have previously been described. The creation of 3D prints displaying patient-specific anatomical pathology for surgical planning and interventions is an emerging field. Here we explored the possibility of taking rare pediatric radiographic data sets to create 3D prints for surgical education. METHODS Magnetic resonance imaging data of 2 children (8 and 14 months) were segmented, colored, and anonymized, and stereolothographic files were prepared for 3D printing on either multicolor plastic or powder 3D printers and multimaterial 3D printers. RESULTS Two models were deemed of sufficient quality and anatomical accuracy to print unamended. One data set was further manipulated digitally to artificially extend the length of the cleft. Thus, 3 models were printed: 1 incomplete soft-palate deformity, 1 incomplete anterior palate deformity, and 1 complete cleft palate. All had cleft lip deformity. The single-material 3D prints are of sufficient quality to accurately identify the nature and extent of the deformities. Multimaterial prints were subsequently created, which could be valuable in surgical training. CONCLUSION Improvements in the quality and resolution of radiographic imaging combined with the advent of multicolor multiproperty printer technology will make it feasible in the near future to print 3D replicas in materials that mimic the mechanical properties and color of live human tissue making them potentially suitable for surgical training.
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McDonald RE, Jeeves AE, Vasey CE, Wright DM, O'Grady G. Supply and demand mismatch for flexible (part‐time) surgical training in Australasia. Med J Aust 2013; 198:423-5. [DOI: 10.5694/mja12.11685] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 03/20/2013] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Carolyn E Vasey
- Royal Australasian College of Surgeons Trainees Association, Melbourne, VIC
| | - Deborah M Wright
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Gregory O'Grady
- Royal Australasian College of Surgeons Trainees Association, Melbourne, VIC
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Perry RE, Oldfield Z. Acquiring surgical skills: the role of the Royal Australasian College of Surgeons. ANZ J Surg 2013; 83:417-21. [DOI: 10.1111/ans.12181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Richard E. Perry
- Royal Australasian College of Surgeons; East Melbourne; Victoria; Australia
| | - Zaita Oldfield
- Royal Australasian College of Surgeons; East Melbourne; Victoria; Australia
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