1
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Habermann AC, Timmerman WR, Cohen SM, Burkhardt BW, Amendola MF. Clinical applications of 3D printing in colorectal surgery: A systematic review. Int J Colorectal Dis 2024; 39:127. [PMID: 39107626 PMCID: PMC11303507 DOI: 10.1007/s00384-024-04695-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The utilization of three-dimensional printing has grown rapidly within the field of surgery over recent years. Within the subspecialty of colorectal surgery, the technology has been used to create personalized anatomical models for preoperative planning, models for surgical training, and occasionally customized implantable devices and surgical instruments. We aim to provide a systematic review of the current literature discussing clinical applications of three-dimensional printing in colorectal surgery. METHODS Full-text studies published in English which described the application of 3D printing in pre-surgical planning, advanced surgical planning, and patient education within the field of colorectal surgery were included. Exclusion criteria were duplicate articles, review papers, studies exclusively dealing with surgical training and/or education, studies which used only virtual models, and studies which described colorectal cancer only as it pertained to other organs. RESULTS Eighteen studies were included in this review. There were two randomized controlled trials, one retrospective outcomes study, five case reports/series, one animal model, and nine technical notes/feasibility studies. There were three studies on advanced surgical planning/device manufacturing, six on pre-surgical planning, two on pelvic anatomy modeling, eight on various types of anatomy modeling, and one on patient education. CONCLUSIONS While more studies with a higher level of evidence are needed, the findings of this review suggest many promising applications of three-dimensional printing within the field of colorectal surgery with the potential to improve patient outcomes and experiences.
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Affiliation(s)
- Alyssa C Habermann
- Department of Surgery, Virginia Commonwealth University, Richmond, USA.
- Department of Surgery, Central Virginia Veterans Affairs Healthcare System, Richmond, USA.
| | - William R Timmerman
- Department of Surgery, Central Virginia Veterans Affairs Healthcare System, Richmond, USA
| | - Stephen M Cohen
- Department of Surgery, Central Virginia Veterans Affairs Healthcare System, Richmond, USA
| | - Brian W Burkhardt
- Office of Advanced Manufacturing Site Lead, Department of Physical Medicine and Rehabilitation, Central Virginia Veterans Affairs Healthcare System, Richmond, USA
| | - Michael F Amendola
- Department of Surgery, Virginia Commonwealth University, Richmond, USA
- Division of Vascular Surgery, Central Virginia Veterans Affairs Healthcare System, Richmond, USA
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Wright JM, Ford JM, Qamar F, Lee M, Halsey JN, Smyth MD, Decker SJ, Rottgers SA. Design and Validation of a 3D Printed Cranio-Facial Simulator: A Novel Tool for Surgical Education. Cleft Palate Craniofac J 2024; 61:997-1006. [PMID: 36635983 DOI: 10.1177/10556656221151096] [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] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To assess the ability of current 3D printing technology to generate a craniofacial bony and soft tissue anatomical model for use in simulating the performance of a fronto-orbital advancement (FOA) osteotomy and then to further assess the value of the model as an educational tool. DESIGN Anatomic models were designed with a process of serial anatomic segmentation/design, 3D printing, dissection, and device refinement. A validation study was conducted with 5 junior and 5 senior plastic surgery residents. The validation study incorporated a multiple-choice Knowledge Assessment test (KA), an Objective Structured Assessment of Technical skills (OSATs), a Global Rating Scale (GRS) and a Michigan Standard Simulation Experience Scale (MiSSES). We compared the scores of both the junior and senior residents and compared junior resident scores, before and after viewing a lecture/demonstration. RESULTS MiSSES showed high face validity with a score of 85.1/90, signifying high satisfaction with the simulator learning experience. Simulation and the lecture/demonstration improved the junior resident average KA score from 5.6/10 to 9.6/10 (P = .02), OSATs score from 32.4/66 to 64.4/66 (P < .001) and GRS score from 13.9/35 to 27.5/35 (P < .001). The senior residents OSATs score of 56.3/66 was higher than the pre-lecture juniors (32.4/66) (P < .001), but lower than the post-lecture juniors (64.4/66) (P < .001). CONCLUSION We have successfully fabricated a 3D printed craniofacial simulator capable of being used as an educational tool alongside traditional surgical training. Next steps would be improving soft tissue realism, inclusion of patient and disease specific anatomy and creation of models for other surgical specialties.
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Affiliation(s)
- Joshua M Wright
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Jonathan M Ford
- Department of Radiology, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Fatima Qamar
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Matthew Lee
- Center for Medical Simulation and Innovative Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Jordan N Halsey
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Matthew D Smyth
- Division of Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Summer J Decker
- Department of Radiology, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - S Alex Rottgers
- Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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Fanizzi C, Carone G, Rocca A, Ayadi R, Petrenko V, Casali C, Rani M, Giachino M, Falsitta LV, Gambatesa E, Galbiati TF, Orena EF, Tramacere I, Riker NI, Mocca A, Schaller K, Meling TR, DiMeco F, Perin A. Simulation to become a better neurosurgeon. An international prospective controlled trial: The Passion study. BRAIN & SPINE 2024; 4:102829. [PMID: 38812880 PMCID: PMC11134543 DOI: 10.1016/j.bas.2024.102829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 05/31/2024]
Abstract
Introduction Surgical training traditionally adheres to the apprenticeship paradigm, potentially exposing trainees to an increased risk of complications stemming from their limited experience. To mitigate this risk, augmented and virtual reality have been considered, though their effectiveness is difficult to assess. Research question The PASSION study seeks to investigate the improvement of manual dexterity following intensive training with neurosurgical simulators and to discern how surgeons' psychometric characteristics may influence their learning process and surgical performance. Material and methods Seventy-two residents were randomized into the simulation group (SG) and control group (CG). The course spanned five days, commencing with assessment of technical skills in basic procedures within a wet-lab setting on day 1. Over the subsequent core days, the SG engaged in simulated procedures, while the CG carried out routine activities in an OR. On day 5, all residents' technical competencies were evaluated. Psychometric measures of all participants were subjected to analysis. Results The SG demonstrated superior performance (p < 0.0001) in the brain tumour removal compared to the CG. Positive learning curves were evident in the SG across the three days of simulator-based training for all tumour removal tasks (all p-values <0.05). No significant differences were noted in other tasks, and no meaningful correlations were observed between performance and any psychometric parameters. Discussion and conclusion A brief and intensive training regimen utilizing 3D virtual reality simulators enhances residents' microsurgical proficiency in brain tumour removal models. Simulators emerge as a viable tool to expedite the learning curve of in-training neurosurgeons.
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Affiliation(s)
- Claudia Fanizzi
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Giovanni Carone
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Alessandra Rocca
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Roberta Ayadi
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Veronika Petrenko
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Cecilia Casali
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Martina Rani
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan,
Italy
| | - Marta Giachino
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan,
Italy
| | - Lydia Viviana Falsitta
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Enrico Gambatesa
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Tommaso Francesco Galbiati
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Eleonora Francesca Orena
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
| | - Irene Tramacere
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
| | - Nicole Irene Riker
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
| | - Alessandro Mocca
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan,
Italy
| | - Karl Schaller
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva
University Hospitals & Faculty of Medicine, Geneva, Switzerland
- Department of Clinical Neurosciences, Division of Neurosurgery, Geneva
University Hospitals & Faculty of Medicine, and SFITS, Geneva,
Switzerland
| | - Torstein Ragnar Meling
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
- Department of Neurosurgery, The National Hospital of Denmark,
Rigshospitalet, Copenhagen, Denmark
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
- Department of Pathophysiology and Transplantation, University of Milano,
Milano, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School,
Baltimore, MD, USA
| | - Alessandro Perin
- Department of Neurosurgery, Fondazione I.R.C.C.S. Istituto Neurologico
“C. Besta”, Milano, Italy
- Besta NeuroSim Center, Fondazione I.R.C.C.S. Istituto Neurologico
Nazionale "C. Besta", Milano, Italy
- Department of Life Sciences, University of Trieste, Trieste,
Italy
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Requena-Pérez MV, Andrés-Cano P, Galán-Romero L, Suffo M. Comparative study of biomodels manufactured using 3D printing techniques for surgical planning and medical training. Expert Rev Med Devices 2024; 21:239-248. [PMID: 38270469 DOI: 10.1080/17434440.2024.2306884] [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: 11/09/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES To obtain 3D printed bone models with a haptic sensation similar to that of the real bone, which will help the surgeon to learn and improve based on practice. METHODS From computed tomography, 3 digital anatomical models of the human proximal femur were created and, by modifying the printing parameters, both cortical and trabecular tissues were simulated, which were combined in a different cortico-cancellous interface depending on the bone segment. The 3 equivalent models obtained were compared with a commercial Sawbone synthetic model and subjected to a series of blind surgical practice trials performed by 5 TOC specialists from a hospital, each of them with different degrees of expertise. A statistical analysis of the qualitative data collected based on the Wilcoxon test, the Spearman correlation matrix, and the Validity Ratio Coefficient was performed. RESULTS The deviations observed in the dimensional study are less than 0.2 millimeter, which confirms the validity of the 3DP-FFF technology to geometrically recreate personalized biomodels with high anatomical precision. CONCLUSIONS The reproductions obtained have given rise to a reliable method that professionals can refine to plan operations with the consequent reduction of time and risks for the patient, as well as for medical training.
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Affiliation(s)
- M V Requena-Pérez
- "Puerta del Mar" Universitiy Hospital, Virgen del Rocío University Hospital; Andalusian Public Foundation for Health Research Management in Seville (FISEVI), Seville, Spain
| | - P Andrés-Cano
- Orthopaedic Surgery and Traumatology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | - L Galán-Romero
- Research Group "Biomedical innovation in osteoarticular surgery". Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, "Puerta del Mar" University Hospital. University of Cádiz, Cádiz, Spain
| | - M Suffo
- Department of Mechanical Engineering and Industrial Design, High Engineering School, Universidad de Cádiz; Avda. de la Universidad nº 10, Puerto Real (Cádiz), Spain
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Smith LT, MacCurdy RB. Digital Multiphase Composites via Additive Manufacturing. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2308491. [PMID: 38181510 DOI: 10.1002/adma.202308491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/20/2023] [Indexed: 01/07/2024]
Abstract
Mechanical properties of traditional engineering materials are typically coupled to each other, presenting a challenge to practitioners with multi-dimensional material property requirements. In this work, continuous, independent control over multiple mechanical properties is demonstrated in composite materials realized using additive manufacturing. For the first time, composites additively manufactured from rigid plastic, soft elastomer, and liquid constituents are experimentally characterized, demonstrating materials which span four orders of magnitude in modulus and two orders of magnitude in toughness. By forming analytical mappings between relative concentrations of constituents at the microscale and resulting macroscale material properties, inverse material design is enabled; the method is showcased by printing artifacts with prescribed toughness and elasticity distributions. The properties of these composites are placed in the context of biological tissues, showing they have promise as mechanically plausible tissue mimics.
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Affiliation(s)
- Lawrence T Smith
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, 1111 Engineering Dr. UCB 427, Boulder, CO, 80309, USA
| | - Robert B MacCurdy
- Paul M. Rady Department of Mechanical Engineering, University of Colorado Boulder, 1111 Engineering Dr. UCB 427, Boulder, CO, 80309, USA
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6
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Valls-Esteve A, Tejo-Otero A, Adell-Gómez N, Lustig-Gainza P, Fenollosa-Artés F, Buj-Corral I, Rubio-Palau J, Munuera J, Krauel L. Advanced Strategies for the Fabrication of Multi-Material Anatomical Models of Complex Pediatric Oncologic Cases. Bioengineering (Basel) 2023; 11:31. [PMID: 38247908 PMCID: PMC10813349 DOI: 10.3390/bioengineering11010031] [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: 10/16/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
The printing and manufacturing of anatomical 3D models has gained popularity in complex surgical cases for surgical planning, simulation and training, the evaluation of anatomical relations, medical device testing and patient-professional communication. 3D models provide the haptic feedback that Virtual or Augmented Reality (VR/AR) cannot provide. However, there are many technologies and strategies for the production of 3D models. Therefore, the aim of the present study is to show and compare eight different strategies for the manufacture of surgical planning and training prototypes. The eight strategies for creating complex abdominal oncological anatomical models, based on eight common pediatric oncological cases, were developed using four common technologies (stereolithography (SLA), selectie laser sinterning (SLS), fused filament fabrication (FFF) and material jetting (MJ)) along with indirect and hybrid 3D printing methods. Nine materials were selected for their properties, with the final models assessed for application suitability, production time, viscoelastic mechanical properties (shore hardness and elastic modulus) and cost. The manufacturing and post-processing of each strategy is assessed, with times ranging from 12 h (FFF) to 61 h (hybridization of FFF and SLS), as labor times differ significantly. Cost per model variation is also significant, ranging from EUR 80 (FFF) to EUR 600 (MJ). The main limitation is the mimicry of physiological properties. Viscoelastic properties and the combination of materials, colors and textures are also substantially different according to the strategy and the intended use. It was concluded that MJ is the best overall option, although its use in hospitals is limited due to its cost. Consequently, indirect 3D printing could be a solid and cheaper alternative.
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Affiliation(s)
- Arnau Valls-Esteve
- Innovation Department, SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- 3D Unit (3D4H), SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Aitor Tejo-Otero
- Centre CIM, Universitat Politècnica de Catalunya (CIM UPC), Carrer de Llorens i Artigas, 12, 08028 Barcelona, Spain
| | - Núria Adell-Gómez
- Innovation Department, SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- 3D Unit (3D4H), SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Pamela Lustig-Gainza
- Innovation Department, SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- 3D Unit (3D4H), SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Felip Fenollosa-Artés
- Centre CIM, Universitat Politècnica de Catalunya (CIM UPC), Carrer de Llorens i Artigas, 12, 08028 Barcelona, Spain
- Department of Mechanical Engineering, Barcelona School of Industrial Engineering (ETSEIB), Universitat Politècnica de Catalunya, Av. Diagonal, 647, 08028 Barcelona, Spain
| | - Irene Buj-Corral
- Department of Mechanical Engineering, Barcelona School of Industrial Engineering (ETSEIB), Universitat Politècnica de Catalunya, Av. Diagonal, 647, 08028 Barcelona, Spain
| | - Josep Rubio-Palau
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- 3D Unit (3D4H), SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Pediatric Surgical Oncology, Pediatric Surgery Department, SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain
- Maxillofacial Unit, Department of Pediatric Surgery, Pediatric Surgical Oncology, SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain
| | - Josep Munuera
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- Diagnostic Imaging Department, Hospital de la Santa Creu i Sant Pau, 08027 Barcelona, Spain
- Advanced Medical Imaging, Artificial Intelligence, and Imaging-Guided Therapy Research Group, Institut de Recerca Sant Pau—Centre CERCA, 08041 Barcelona, Spain
| | - Lucas Krauel
- Medicina i Recerca Translacional, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
- 3D Unit (3D4H), SJD Barcelona Children’s Hospital, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
- Pediatric Surgical Oncology, Pediatric Surgery Department, SJD Barcelona Children’s Hospital, Universitat de Barcelona, 08950 Barcelona, Spain
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Payen C, Carsuzaa F, Gallet P, Favier V. Porcine model for tracheostomy training: evaluation of the content and construct validity. Eur Arch Otorhinolaryngol 2023; 280:5631-5636. [PMID: 37743361 DOI: 10.1007/s00405-023-08232-1] [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: 06/28/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Tracheostomy is a key procedure that residents in Oto-Rhino-Laryngology, Head and Neck surgery must master as a fundamental component of their training. Swine is a potential model for tracheostomy training as it mimics human anatomy and provides realistic haptic feedback. The purpose of this study is to evaluate its content and construct validity in surgical tracheostomy training. METHODS We carried out training sessions on dead swine with three groups of volunteers: young residents [postgraduate year (PGY)-1 to 3], experienced residents (PGY-4 to 6) and senior surgeons. Content validity was studied using questionnaires sent to senior surgeons. Construct validity was assessed by comparing the OSATS score on video analysis, between the three groups. RESULTS 19 individuals participated in the training sessions. OSATS score were statistically different between groups (p < 0.05) with a mean score of 19 for young residents, 24.7 for experienced residents and 31.3 for senior surgeon, with a good inter-rater reliability (Pearson coefficient > 0.9). Experienced surgeons agreed that the model was a useful training tool, strongly agreed that it improved performance, and that it would be used to train their students. CONCLUSIONS The dead pig is a suitable model to train for human tracheotomy, with good content and construction validity.
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Affiliation(s)
- Caroline Payen
- Faculté de médecine de Montpellier-Nîmes, Université Montpellier, 641 Avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | - Florent Carsuzaa
- Service ORL, Chirurgie Cervico-Maxillo-Faciale et Audiophonologie, Centre Hospitalier Universitaire de Poitiers, 86000, Poitiers, France
- Laboratoire Inflammation Tissus Epithéliaux et Cytokines (LITEC), UR15560, Université de Poitiers, 86000, Poitiers, France
| | - Patrice Gallet
- Département d'ORL, Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, Vandoeuvre-lès-Nancy, France
- NGERE, INSERM Laboratoire U1256, Université de Lorraine, Vandoeuvre-lès-Nancy, France
- Ecole de chirurgie de Nancy-Lorraine, Hôpital Virtuel de Lorraine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Valentin Favier
- Faculté de médecine de Montpellier-Nîmes, Université Montpellier, 641 Avenue du Doyen Gaston Giraud, 34000, Montpellier, France.
- Département d'ORL, chirurgie cervico faciale et maxillo-faciale, Hôpital Gui de Chauliac, Centre Hospitalier Universitaire de Montpellier, 80 Avenue Augustin Fliche, Montpellier, France.
- Research-Team ICAR, Laboratory of Computer Science, Robotics and Microelectronics of Montpellier (LIRMM), Univ. Montpellier, French National Centre for Scientific Research (CNRS), Montpellier, France.
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8
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Payen C, Gallet P, Lechien JR, Favier V. Teachers should apply the principle of reduction for more sustainable surgical simulation practice: the example of training pharyngolaryngeal surgery in a porcine model. Front Med (Lausanne) 2023; 10:1226475. [PMID: 37711745 PMCID: PMC10499042 DOI: 10.3389/fmed.2023.1226475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/11/2023] [Indexed: 09/16/2023] Open
Affiliation(s)
- Caroline Payen
- Faculty of Medicine, Montpellier University, Montpellier, France
| | - Patrice Gallet
- Otolaryngology–Head and Neck Surgery Department, Nancy Regional University Hospital, Lorraine University, Nancy, France
- Nancy-Lorraine School of Surgery, Virtual Hospital of Lorraine (HVL), Lorraine University, Nancy, France
- NGERE Team, INSERM U1256, Lorraine University, Nancy, France
| | - Jérôme R. Lechien
- Otolaryngology–Head and Neck Surgery Department, EpiCURA Hospital, Mons University, Mons, Belgium
- Otolaryngology–Head and Neck Surgery Department, Foch Hospital, Suresnes, France
| | - Valentin Favier
- Faculty of Medicine, Montpellier University, Montpellier, France
- Research-Team ICAR, Laboratory of Computer Science, Robotics and Microelectronics of Montpellier (LIRMM), Univ. Montpellier, French National Centre for Scientific Research (CNRS), Montpellier, France
- YO-IFOS Group for Sustainable Development, Young Members of International Federation of Otolaryngology Societies, Paris, France
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9
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McMenamin PG. The Third Dimension: 3D Printed Replicas and Other Alternatives to Cadaver-Based Learning. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1421:39-61. [PMID: 37524983 DOI: 10.1007/978-3-031-30379-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Capturing the 'third dimension' of complex human form or anatomy has been an objective of artists and anatomists from the renaissance in the fifteenth and sixteenth centuries onwards. Many of these drawings, paintings, and sculptures have had a profound influence on medical teaching and the learning resources we took for granted until around 40 years ago. Since then, the teaching of human anatomy has undergone significant change, especially in respect of the technologies available to augment or replace traditional cadaver-based dissection instruction. Whilst resources such as atlases, wall charts, plastic models, and images from the Internet have been around for many decades, institutions looking to reduce the reliance on dissection-based teaching in medical or health professional training programmes have in more recent times increasingly had access to a range of other options for classroom-based instruction. These include digital resources and software programmes and plastinated specimens, although the latter come with a range of ethical and cost considerations. However, the urge to recapitulate the 'third dimension' of anatomy has seen the recent advent of novel resources in the form of 3D printed replicas. These 3D printed replicas of normal human anatomy dissections are based on a combination of radiographic imaging and surface scanning that captures critical 3D anatomical information. The final 3D files can either be augmented with false colour or made to closely resemble traditional prosections prior to printing. This chapter details the journey we and others have taken in the search for the 'third dimension'. The future of a haptically identical, anatomically accurate replica of human cadaver specimens for surgical and medical training is nearly upon us. Indeed, the need for hard copy replicas may eventually be superseded by the opportunities afforded by virtual reality (VR) and augmented reality (AR).
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Affiliation(s)
- Paul G McMenamin
- Faculty of Medicine, Nursing and Health Sciences, Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC, Australia.
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10
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Nuber M, Gonzalez-Uarquin F, Neufurth M, Brockmann MA, Baumgart J, Baumgart N. Development of a 3D simulator for training the mouse in utero electroporation. PLoS One 2022; 17:e0279004. [PMID: 36516187 PMCID: PMC9749995 DOI: 10.1371/journal.pone.0279004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
In utero electroporation (IUE) requires high-level training in microinjection through the mouse uterine wall into the lateral ventricle of the mouse brain. Training for IUE is currently being performed in live mice as no artificial models allow simulations yet. This study aimed to develop an anatomically realistic 3D printed simulator to train IUE in mice. To this end, we created embryo models containing lateral ventricles. We coupled them to uterus models in six steps: (1) computed tomography imaging, (2) 3D model segmentation, (3) 3D model refinement, (4) mold creation to cast the actual model, (5) 3D mold printing, and (6) mold casting the molds with a mix of soft silicones to ensure the hardness and consistency of the uterus and embryo. The results showed that the simulator assembly successfully recreated the IUE. The compression test did not differ in the mechanical properties of the real embryo or in the required load for uterus displacement. Furthermore, more than 90% of the users approved the simulator as an introduction to IUE and considered that the simulator could help reduce the number of animals for training. Despite current limitations, our 3D simulator enabled a realistic experience for initial approximations to the IUE and is a real alternative for implementing the 3Rs. We are currently working on refining the model.
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Affiliation(s)
- Maximilian Nuber
- Translational Animal Research Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Fernando Gonzalez-Uarquin
- Translational Animal Research Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Meik Neufurth
- Institute of Physiological Chemistry, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Marc A. Brockmann
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Jan Baumgart
- Translational Animal Research Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Nadine Baumgart
- Translational Animal Research Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- * E-mail:
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11
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Jaksa L, Pahr D, Kronreif G, Lorenz A. Development of a Multi-Material 3D Printer for Functional Anatomic Models. Int J Bioprint 2021; 7:420. [PMID: 34805598 PMCID: PMC8600298 DOI: 10.18063/ijb.v7i4.420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/01/2021] [Indexed: 01/19/2023] Open
Abstract
Anatomic models are important in medical education and pre-operative planning as they help students or doctors prepare for real scenarios in a risk-free way. Several experimental anatomic models were made with additive manufacturing techniques to improve geometric, radiological, or mechanical realism. However, reproducing the mechanical behavior of soft tissues remains a challenge. To solve this problem, multi-material structuring of soft and hard materials was proposed in this study, and a three-dimensional (3D) printer was built to make such structuring possible. The printer relies on extrusion to deposit certain thermoplastic and silicone rubber materials. Various objects were successfully printed for testing the feasibility of geometric features such as thin walls, infill structuring, overhangs, and multi-material interfaces. Finally, a small medical image-based ribcage model was printed as a proof of concept for anatomic model printing. The features enabled by this printer offer a promising outlook on mimicking the mechanical properties of various soft tissues.
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Affiliation(s)
- Laszlo Jaksa
- Austrian Center for Medical Innovation and Technology (ACMIT Gmbh), Viktor-Kaplan-Strasse 2/A, 2700 Wiener Neustadt, Austria.,Technical University of Vienna, Institute of Lightweight Design and Structural Biomechanics, Object 8, Gumpendorfer Strasse 7, 1060 Vienna, Austria
| | - Dieter Pahr
- Technical University of Vienna, Institute of Lightweight Design and Structural Biomechanics, Object 8, Gumpendorfer Strasse 7, 1060 Vienna, Austria.,Karl Landsteiner University of Health Sciences, Department of Anatomy and Biomechanics, Dr.-Karl-Dorrek-Strasse 30, 3500 Krems an der Donau, Austria
| | - Gernot Kronreif
- Austrian Center for Medical Innovation and Technology (ACMIT Gmbh), Viktor-Kaplan-Strasse 2/A, 2700 Wiener Neustadt, Austria
| | - Andrea Lorenz
- Austrian Center for Medical Innovation and Technology (ACMIT Gmbh), Viktor-Kaplan-Strasse 2/A, 2700 Wiener Neustadt, Austria
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12
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Lin JC, Welle N, Ding J, Chuen J. A look to the future: Pandemic-induced digital technologies in vascular surgery. Semin Vasc Surg 2021; 34:139-151. [PMID: 34642034 PMCID: PMC8502076 DOI: 10.1053/j.semvascsurg.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
Like many areas of medicine, vascular surgery has been transformed by the COVID-19 (coronavirus disease 2019) pandemic. Public health precautions to minimize disease transmission have led to reduced attendance at hospitals and clinics in elective and emergency settings; fewer face-to-face and hands-on clinical interactions; and increased reliance on telemedicine, virtual attendance, investigations, and digital therapeutics. However, a “silver lining” to the COVID-19 pandemic may be the mainstream acceptance and acceleration of telemedicine, remote monitoring, digital health technology, and three-dimensional technologies, such as three-dimensional printing and virtual reality, by connecting health care providers to patients in a safe, reliable, and timely manner, and supplanting face-to-face surgical simulation and training. This review explores the impact of these changes in the delivery of vascular surgical care.
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Affiliation(s)
- Judith C Lin
- Michigan State University College of Human Medicine 4660 S. Hagadorn Rd. Ste. #600 East Lansing, MI 48823.
| | - Nicholas Welle
- Michigan State University College of Osteopathic Medicine, Lansing, MI
| | - Joel Ding
- Austin Health Department of Surgery, The University of Melbourne, Heidelberg, Australia
| | - Jason Chuen
- Austin Health Department of Surgery, The University of Melbourne, Heidelberg, Australia
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13
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Nica DF, Gabor AG, Duma VF, Tudericiu VG, Tudor A, Sinescu C. Sinus Lift and Implant Insertion on 3D-Printed Polymeric Maxillary Models: Ex Vivo Training for In Vivo Surgical Procedures. J Clin Med 2021; 10:jcm10204718. [PMID: 34682841 PMCID: PMC8538196 DOI: 10.3390/jcm10204718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives: The aim of this study is to demonstrate the increased efficiency achieved by dental practitioners when carrying out an ex vivo training process on 3D-printed maxillaries before performing in vivo surgery. Materials and Methods: This developed ex vivo procedure comprises the following phases: (i) scanning the area of interest for surgery; (ii) obtaining a 3D virtual model of this area using Cone Beam Computed Tomography (CBCT); (iii) obtaining a 3D-printed model (based on the virtual one), on which (iv) the dental practitioner simulates/rehearses ex vivo (most of) the surgery protocol; (v) assess with a new CBCT the 3D model after simulation. The technical steps of sinus augmentation and implant insertion could be performed on the corresponding 3D-printed hemi-maxillaries prior to the real in vivo surgery. Two study groups were considered, with forty patients divided as follows: Group 1 comprises twenty patients on which the developed simulation and rehearsal procedure was applied; Group 2 is a control one which comprises twenty patients on which similar surgery was performed without this procedure (considered in order to compare operative times without and with rehearsals). Results: Following the ex vivo training/rehearsal, an optimal surgery protocol was developed for each considered case. The results of the surgery on patients were compared with the results obtained after rehearsals on 3D-printed models. The performed quantitative assessment proved that, using the proposed training procedure, the results of the in vivo surgery are not significantly different (p = 0.089) with regard to the ex vivo simulation for both the mezio-distal position of the implant and the distance from the ridge margin to sinus window. On the contrary, the operative time of Group 1 was reduced significantly (p = 0.001), with an average of 20% with regard to in vivo procedures performed without rehearsals (on the control Group 2). Conclusions: The study demonstrated that the use of 3D-printed models can be beneficial to dental surgeon practitioners, as well as to students who must be trained before performing clinical treatments.
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Affiliation(s)
- Diana Florina Nica
- School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 2A Eftimie Murgu Place, 300070 Timisoara, Romania;
| | - Alin Gabriel Gabor
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania; (A.G.G.); (A.T.); (C.S.)
| | - Virgil-Florin Duma
- 3OM Optomechatronics Group, Faculty of Engineering, “Aurel Vlaicu” University of Arad, 2 Elena Dragoi, 310177 Arad, Romania
- Doctoral School, Polytechnic University of Timisoara, 1 Mihai Viteazu Ave., 300222 Timisoara, Romania
- Correspondence: ; Tel.: +40-751-511451
| | | | - Anca Tudor
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania; (A.G.G.); (A.T.); (C.S.)
| | - Cosmin Sinescu
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania; (A.G.G.); (A.T.); (C.S.)
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Yang S, Lin H, Luo C. Meta-Analysis of 3D Printing Applications in Traumatic Fractures. Front Surg 2021; 8:696391. [PMID: 34532337 PMCID: PMC8439573 DOI: 10.3389/fsurg.2021.696391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Traumatic fracture is a common orthopaedic disease, and application of 3D printing technology in fracture treatment, which entails utilisation of pre-operative printed anatomic fracture model, is increasingly gaining popularity. However, effectiveness of 3D printing-assisted surgery lacks evidence-based findings to support its application. Materials and Methods: Embase, PubMed and Cochrane Library databases were systematically searched until October, 2020 to identify relevant studies. All randomised controlled trials (RCTs) comparing efficacy of 3D printing-assisted surgery vs. conventional surgery for traumatic fractures were reviewed. RevMan V.5.3 software was used to conduct meta-analysis. Results: A total of 12 RCTs involving 641 patients were included. Pooled findings showed that 3D printing-assisted surgery had shorter operation duration [standardised mean difference (SMD) = −1.52, 95% confidence interval (CI) – 1.70 ~ −1.34, P < 0.00001], less intraoperative blood loss (SMD = 1.34, 95% CI 1.74 ~ 0.94, P < 0.00001), fewer intraoperative fluoroscopies (SMD = 1.25, 95% CI 1.64 ~ 0.87, P < 0.00001), shorter fracture union time (SMD = −0.15, 95% CI −0.25 ~ −0.05, P = 0.003), and higher rate of excellent outcomes (OR = 2.40, 95% CI 1.07 ~ 5.37, P = 0.03) compared with conventional surgery. No significant differences in complication rates were observed between the two types of surgery (OR = 0.69, 95% CI 0.69 ~ 1.42, P = 0.32). Conclusions: Indicators including operation duration, intraoperative blood loss, number of intraoperative fluoroscopies, fracture union time, and rates of excellent outcomes showed that 3D printing-assisted surgery is a superior alternative in treatment of traumatic fractures compared with conventional surgery. Moreover, the current study did not report significant differences in incidence of complications between the two approaches. Systematic Review Registration: CRD42021239507.
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Affiliation(s)
- Sha Yang
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Huapeng Lin
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cong Luo
- Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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15
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Naghieh S, Lindberg G, Tamaddon M, Liu C. Biofabrication Strategies for Musculoskeletal Disorders: Evolution towards Clinical Applications. Bioengineering (Basel) 2021; 8:123. [PMID: 34562945 PMCID: PMC8466376 DOI: 10.3390/bioengineering8090123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 12/26/2022] Open
Abstract
Biofabrication has emerged as an attractive strategy to personalise medical care and provide new treatments for common organ damage or diseases. While it has made impactful headway in e.g., skin grafting, drug testing and cancer research purposes, its application to treat musculoskeletal tissue disorders in a clinical setting remains scarce. Albeit with several in vitro breakthroughs over the past decade, standard musculoskeletal treatments are still limited to palliative care or surgical interventions with limited long-term effects and biological functionality. To better understand this lack of translation, it is important to study connections between basic science challenges and developments with translational hurdles and evolving frameworks for this fully disruptive technology that is biofabrication. This review paper thus looks closely at the processing stage of biofabrication, specifically at the bioinks suitable for musculoskeletal tissue fabrication and their trends of usage. This includes underlying composite bioink strategies to address the shortfalls of sole biomaterials. We also review recent advances made to overcome long-standing challenges in the field of biofabrication, namely bioprinting of low-viscosity bioinks, controlled delivery of growth factors, and the fabrication of spatially graded biological and structural scaffolds to help biofabricate more clinically relevant constructs. We further explore the clinical application of biofabricated musculoskeletal structures, regulatory pathways, and challenges for clinical translation, while identifying the opportunities that currently lie closest to clinical translation. In this article, we consider the next era of biofabrication and the overarching challenges that need to be addressed to reach clinical relevance.
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Affiliation(s)
- Saman Naghieh
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK S7N 5A9, Canada
| | - Gabriella Lindberg
- Christchurch Regenerative Medicine and Tissue Engineering (CReaTE) Group, Department of Orthopaedic Surgery, University of Otago Christchurch, Christchurch 8011, New Zealand
- Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR 97403, USA
| | - Maryam Tamaddon
- Institute of Orthopaedic & Musculoskeletal Science, Royal National Orthopaedic Hospital, University College London, Stanmore HA7 4LP, UK
| | - Chaozong Liu
- Institute of Orthopaedic & Musculoskeletal Science, Royal National Orthopaedic Hospital, University College London, Stanmore HA7 4LP, UK
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16
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Li R, Ting YH, Youssef SH, Song Y, Garg S. Three-Dimensional Printing for Cancer Applications: Research Landscape and Technologies. Pharmaceuticals (Basel) 2021; 14:ph14080787. [PMID: 34451884 PMCID: PMC8401566 DOI: 10.3390/ph14080787] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 02/07/2023] Open
Abstract
As a variety of novel technologies, 3D printing has been considerably applied in the field of health care, including cancer treatment. With its fast prototyping nature, 3D printing could transform basic oncology discoveries to clinical use quickly, speed up and even revolutionise the whole drug discovery and development process. This literature review provides insight into the up-to-date applications of 3D printing on cancer research and treatment, from fundamental research and drug discovery to drug development and clinical applications. These include 3D printing of anticancer pharmaceutics, 3D-bioprinted cancer cell models and customised nonbiological medical devices. Finally, the challenges of 3D printing for cancer applications are elaborated, and the future of 3D-printed medical applications is envisioned.
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Wu CA, Squelch A, Sun Z. Investigation of Three-dimensional Printing Materials for Printing Aorta Model Replicating Type B Aortic Dissection. Curr Med Imaging 2021; 17:843-849. [PMID: 33602103 DOI: 10.2174/1573405617666210218102046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/25/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022]
Abstract
AIM This study aims to determine a printing material that has both elastic property and radiology equivalence close to the real aorta for simulation of endovascular stent-graft repair of aortic dissection. BACKGROUND With the rapid development of Three-Dimensional (3D) printing technology, a patient- specific 3D printed model is able to help surgeons to make a better treatment plan for Type B aortic dissection patients. However, the radiological properties of most 3D printing materials have not been well characterized. This study aims to investigate the appropriate materials for printing human aorta with mechanical and radiological properties similar to the real aortic Computed Tomography (CT) attenuation. OBJECTIVE Quantitative assessment of CT attenuation of different materials used in 3D printed models of aortic dissection for developing patient-specific 3D printed aorta models to simulate type B aortic dissection. METHODS A 25-mm length of aorta model was segmented from a patient's image dataset with a diagnosis of type B aortic dissection. Four different elastic commercial 3D printing materials, namely Agilus A40 and A50, Visijet CE-NT A30 and A70 were selected and printed with different hardness. Totally four models were printed out and CT scanned twice on a 192-slice CT scanner using the standard aortic CT angiography protocol, with and without contrast inside the lumen. Five reference points with the Region Of Interest (ROI) of 1.77 mm2 were selected at the aortic wall, and intimal flap and their Hounsfield units (HU) were measured and compared with the CT attenuation of original CT images. The comparison between the patient's aorta and models was performed through a paired-sample t-test to determine if there is any significant difference. RESULTS The mean CT attenuation of the aortic wall of the original CT images was 80.7 HU. Analysis of images without using contrast medium showed that the material of Agilus A50 produced the mean CT attenuation of 82.6 HU, which is similar to that of original CT images. The CT attenuation measured at images acquired with the other three materials was significantly lower than that of the original images (p<0.05). After adding contrast medium, Visijet CE-NT A30 had an average CT attenuation of 90.6 HU, which is close to that of the original images without a statistically significant difference (p>0.05). In contrast, the CT attenuation measured at images acquired with other three materials (Agilus A40, A50 and Visiject CE-NT A70) was 129 HU, 135 HU and 129.6 HU, respectively, which is significantly higher than that of original CT images (p<0.05). CONCLUSION Both Visijet CE-NT and Agilus have tensile strength and elongation close to actual patient's tissue properties producing similar CT attenuation. Visijet CE-NT A30 is considered the appropriate material for printing aorta to simulate contrast-enhanced CT imaging of type B aortic dissection. Due to the lack of body phantoms in the experiments, further research with the simulation of realistic anatomical body environment should be conducted.
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Affiliation(s)
- Chia-An Wu
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, 6845, Australia
| | - Andrew Squelch
- Discipline of Exploration Geophysics, WA School of Mines: Mineral, Energy and Chemical Engineering, Curtin University, Perth, 6845, Australia
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, 6845, Australia
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Fillat-Gomà F, Marcano-Fernández FA, Coderch-Navarro S, Martínez-Carreres L, Berenguer A. 3D printing innovation: New insights into upper extremity surgery planning. Injury 2021; 52 Suppl 4:S117-S124. [PMID: 33632605 DOI: 10.1016/j.injury.2021.01.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/19/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical planning relies on the use of images to develop an action plan prior to the actual surgical intervention. Imaging technology improvement together with the development of specific software to treat three dimensional images has increased the accuracy and capabilities of pre-surgical planning. In addition to this, 3D printing allows us to manufacture customized surgical tools to implement and aid in the success of surgeries. MATERIAL AND METHODS 3D virtual planning together with 3D printing has been implemented through different approaches in 8 different upper extremity trauma cases. We describe these 8 cases (2 women and 6 men with ages ranging from 16 to 67 years), their specific challenges and management. RESULTS We show how 3D technology changes the conception, planning and execution of surgery in 8 different cases. In addition, we describe what challenges were faced as well as the various utilities of 3D technology beyond that of anatomical model printing. CONCLUSIONS The use of 3D technology has improved and enhanced surgical planning. It allows us to view and virtually manipulate fracture fragments prior to surgery. It also enables us to develop customized surgical tools and guides that can increase the accuracy of certain procedures, and help in the management of orthopaedic and trauma lesions. We believe that the use of this technology is beneficial to both the patient and surgeon, since it reduces surgical time and complications giving a better understanding of the injury and its treatment.
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Affiliation(s)
- Ferran Fillat-Gomà
- Orthopedic Department. Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Sabadell, Spain; 3D Surgical Planning Lab. Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Sabadell, Spain.
| | - Francesc Antoni Marcano-Fernández
- Orthopedic Department. Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Sabadell, Spain
| | - Sergi Coderch-Navarro
- 3D Surgical Planning Lab. Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Sabadell, Spain
| | - Laia Martínez-Carreres
- Orthopedic Department. Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Sabadell, Spain; 3D Surgical Planning Lab. Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Sabadell, Spain
| | - Alex Berenguer
- Orthopedic Department. Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona. Sabadell, Spain
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Pugalendhi A, Ranganathan R. A review of additive manufacturing applications in ophthalmology. Proc Inst Mech Eng H 2021; 235:1146-1162. [PMID: 34176362 DOI: 10.1177/09544119211028069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Additive Manufacturing (AM) capabilities in terms of product customization, manufacture of complex shape, minimal time, and low volume production those are very well suited for medical implants and biological models. AM technology permits the fabrication of physical object based on the 3D CAD model through layer by layer manufacturing method. AM use Magnetic Resonance Image (MRI), Computed Tomography (CT), and 3D scanning images and these data are converted into surface tessellation language (STL) file for fabrication. The applications of AM in ophthalmology includes diagnosis and treatment planning, customized prosthesis, implants, surgical practice/simulation, pre-operative surgical planning, fabrication of assistive tools, surgical tools, and instruments. In this article, development of AM technology in ophthalmology and its potential applications is reviewed. The aim of this study is nurturing an awareness of the engineers and ophthalmologists to enhance the ophthalmic devices and instruments. Here some of the 3D printed case examples of functional prototype and concept prototypes are carried out to understand the capabilities of this technology. This research paper explores the possibility of AM technology that can be successfully executed in the ophthalmology field for developing innovative products. This novel technique is used toward improving the quality of treatment and surgical skills by customization and pre-operative treatment planning which are more promising factors.
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Affiliation(s)
- Arivazhagan Pugalendhi
- Department of Mechanical Engineering, Coimbatore Institute of Technology, Coimbatore, Tamil Nadu, India
| | - Rajesh Ranganathan
- Department of Mechanical Engineering, Coimbatore Institute of Technology, Coimbatore, Tamil Nadu, India
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Favier V, Ayad T, Blanc F, Fakhry N, Andersen SAW. Use of simulation-based training of surgical technical skills among ENTs: an international YO-IFOS survey. Eur Arch Otorhinolaryngol 2021; 278:5043-5050. [PMID: 33914149 DOI: 10.1007/s00405-021-06846-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/21/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to investigate and compare the use of simulation-based technical skills training (SBTST) in the otolaryngology curriculum in different countries, and to explore the needs and opinions about the use of simulation among young otolaryngologists. METHODS An e-survey conducted among Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (Yo-IFOS) members. RESULTS 139 Yo-IFOS members from 51 countries completed the survey. During residency training, 82.7% of respondents have used SBTST on cadavers, 51.8% on physical simulators, and 43.8% on virtual reality simulators. High costs (65.5%), lack of availability (49.2%) and lack of time (25.5%) were the main barriers limiting the practice of SBTST. These barriers also limited teaching using simulation. Sinonasal surgery (72.7%), temporal bone surgery (67.6%), and head/neck surgery (44.6%) were significantly more frequently taught using SBTST than suspension microlaryngoscopy (25.9%) and pediatric surgery (22.3%) (p < 0.001). The procedures rated as the most important to learn through SBTST were tracheotomy (50.4%), emergency cricothyroidotomy (48.9%), and rigid bronchoscopy (47.5%). On an analogic visual scale (0-100) for the question "how important will simulation be for future ENTs in surgical training?", the mean score was 79.5/100 (± 23.3), highlighting the positive attitude toward the use of SBTST in otorhinolaryngology training. CONCLUSION SBTST is an attractive learning and teaching method in otorhinolaryngology, but associated costs, lack of access, and lack of time are the main barriers limiting its use. Emergency procedures are key technical skills to be learned using simulation but in some cases, lack relevant simulators for training.
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Affiliation(s)
- Valentin Favier
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France.
- Montpellier Laboratory of Informatics, Robotics and Microelectonics (LIRMM), ICAR Team, French National Centre for Scientific Research (CNRS), Montpellier University, Montpellier, France.
| | - Tareck Ayad
- Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France
- Division of Otolaryngology-Head & Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Fabian Blanc
- Department of Otolaryngology, Head and Neck Surgery, University Hospital of Montpellier, 80 Avenue Augustin Fliche, 34000, Montpellier, France
| | - Nicolas Fakhry
- Young-Otolaryngologists of the International Federations of Otorhinolaryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology, Head & Neck Surgery, APHM, Aix Marseille University, La Conception University Hospital, Marseille, France
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology, Head & Neck Surgery, Rigshospitalet, Copenhagen, Denmark
- Center for HR & Education, RegionH, Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark
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21
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Masri S, Fauzi MB. Current Insight of Printability Quality Improvement Strategies in Natural-Based Bioinks for Skin Regeneration and Wound Healing. Polymers (Basel) 2021; 13:1011. [PMID: 33805995 PMCID: PMC8036878 DOI: 10.3390/polym13071011] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023] Open
Abstract
Skin tissue engineering aimed to replace chronic tissue injury commonly occurred due to severe burn and chronic wound in diabetic ulcer patients. The normal skin is unable to be regenerated until the seriously injured tissue is disrupted and losing its function. 3D-bioprinting has been one of the effective methods for scaffold fabrication and is proven to replace the conventional method, which reported several drawbacks. In light of this, researchers have developed a new fabrication approach via 3D-bioprinting by combining biomaterials (bioinks) with cells and biomolecules followed by a suitable crosslinking approach. This advanced technology has been subcategorised into three different printing techniques including inject-based, laser-based, and extrusion-based printing. However, the printable quality of the currently available bioinks demonstrated shortcomings in the physicochemical and mechanical properties. This review aims to identify the limitations raised by using natural-based bioinks and the optimum temperature for various applied printing techniques. It is essential to ensure maintaining the acceptable printed scaffold property such as the optimum pore sizes and porosity that allow cell migration activity. In addition, the properties required for an ideal bioinks design for better scaffold printability were also summarised.
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Affiliation(s)
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia;
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22
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Lemarteleur V, Peycelon M, Sablayrolles JL, Plaisance P, El-Ghoneimi A, Ceccaldi PF. Realization of Open Software Chain for 3D Modeling and Printing of Organs in Simulation Centers: Example of Renal Pelvis Reconstruction. JOURNAL OF SURGICAL EDUCATION 2021; 78:232-244. [PMID: 32703739 DOI: 10.1016/j.jsurg.2020.06.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/26/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Three-dimensional (3D) printing has many uses in healthcare such as in surgical training. It is becoming an interesting tool finding new pedagogical purposes in medical simulation. In this study, using a process consisting of 3D modeling, a simulator dedicated to pyeloplasty was designed, manufactured, and evaluated by experts. DESIGN With the aid of open-source software and computer-aided design software, 3D models of a renal parenchyma, a renal pelvis and a ureter were created. This renal apparatus was processed and crafted with additive manufacturing using soft polymer materials. Polyvinyl alcohol material was used to print the components in order to make them dissectible and to evaluate their use in surgical teaching. SETTING AND PARTICIPANTS Seven expert surgeons evaluated the model by performing a pyeloplasty sequence established in a previous work. An evaluation grid with 8 items related to surgical movement was rated on a 5-point Likert scale to assess how similar working with the model was to actual surgery. RESULTS Three items were rated with a score greater than or equal to 4 (Needle penetration, Thread-sliding, and Cutting Strength). Suture strength was rated with a score above 3.5 for both renal pelvis and ureter, whereas elasticity was rated below 3. Handling and mobility properties were rated above 3 for the renal pelvis and below 3 for the ureter. The cost of the unit was $0.30 per renal unit. The primary difference identified was a difference in elongation between polyvinyl alcohol material and real biological tissue. CONCLUSIONS It is feasible to generate and print a low cost upper urinary tract model from patient data imagery using environmentally friendly products that can be used effectively in surgical training. The simulator has been able to reproduce sensations related to surgical movements for a low cost. Hereafter, research into the pedagogical benefits provided to students, and through them, patients, should be performed. 3D printing models can offer new opportunities for healthcare simulation specific to different surgical fields.
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Affiliation(s)
- Vincent Lemarteleur
- Simulation Centre of University of Paris, iLumens Paris Diderot, Paris, France.
| | - Matthieu Peycelon
- Pediatric Urology Department, Robert Debré University Hospital, AP-HP Nord, APHP; Reference Center for Rare Diseases (CRMR) Malformations Rares des Voies Urinaires (MARVU), Paris, France
| | | | - Patrick Plaisance
- Simulation Centre of University of Paris, iLumens Paris Diderot, Paris, France
| | - Alaa El-Ghoneimi
- Pediatric Urology Department, Robert Debré University Hospital, AP-HP Nord, APHP; Reference Center for Rare Diseases (CRMR) Malformations Rares des Voies Urinaires (MARVU), Paris, France
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23
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3D Printing and NIR Fluorescence Imaging Techniques for the Fabrication of Implants. MATERIALS 2020; 13:ma13214819. [PMID: 33126650 PMCID: PMC7662749 DOI: 10.3390/ma13214819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022]
Abstract
Three-dimensional (3D) printing technology holds great potential to fabricate complex constructs in the field of regenerative medicine. Researchers in the surgical fields have used 3D printing techniques and their associated biomaterials for education, training, consultation, organ transplantation, plastic surgery, surgical planning, dentures, and more. In addition, the universal utilization of 3D printing techniques enables researchers to exploit different types of hardware and software in, for example, the surgical fields. To realize the 3D-printed structures to implant them in the body and tissue regeneration, it is important to understand 3D printing technology and its enabling technologies. This paper concisely reviews 3D printing techniques in terms of hardware, software, and materials with a focus on surgery. In addition, it reviews bioprinting technology and a non-invasive monitoring method using near-infrared (NIR) fluorescence, with special attention to the 3D-bioprinted tissue constructs. NIR fluorescence imaging applied to 3D printing technology can play a significant role in monitoring the therapeutic efficacy of 3D structures for clinical implants. Consequently, these techniques can provide individually customized products and improve the treatment outcome of surgeries.
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24
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Riedle H, Chaban R, Ghazy A, Piplat C, Dorweiler B, Franke J. Experimental determination of the suture behavior of aortic tissue in comparison to 3D printed silicone modelling material. J Mech Behav Biomed Mater 2020; 112:104033. [PMID: 32882678 DOI: 10.1016/j.jmbbm.2020.104033] [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: 10/27/2019] [Revised: 02/25/2020] [Accepted: 08/08/2020] [Indexed: 11/16/2022]
Abstract
The imitation of biological tissue in a synthetic physical model can benefit many medical applications, e.g. pre surgical planning or education. For a quantitative validation of the model's mechanical behavior, standardized testing on both, the biological original and the artificial material, is necessary. In four parts, this study focuses on the biomechanical analysis of the impact of sutures for aortic modelling using 3D printed silicone. Testing methods are developed and executed on biological and synthetic samples. The first part is the determination of the pullout strength of a single stitch. The second part is the investigation of the reduction of the tensile strength and elongation of tensile bars due to stitching. Third, the tensile testing of biological and artificial vessels repaired with an anastomosis gives information about the transferability to real surgical applications. A qualitative feedback study with surgical experts concludes the evaluation. The study reveals that the pullout strength is independent from the fiber or notch direction, but that repaired aortic tensile bars show a dependency on the fiber direction of the tissue. Additionally, the circular seam of the anastomosis provides a more stable connection than multiple single stitches. For the artificial models, the mechanical behavior mainly depends on the mechanical properties of the base silicone, here represented by the Shore A hardness, rather than the manufacturing process. When compared to the biological original the most similar material varies depending on the mechanical property in focus.
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Affiliation(s)
- Hannah Riedle
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-University of Erlangen-Nuremberg, Egerlandstr. 7-9, 91058, Erlangen, Germany.
| | - Ryan Chaban
- Cardiothoracic & Vascular Surgery and Research Platform BiomaTiCS, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ahmed Ghazy
- Cardiothoracic & Vascular Surgery and Research Platform BiomaTiCS, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Charlotte Piplat
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-University of Erlangen-Nuremberg, Egerlandstr. 7-9, 91058, Erlangen, Germany
| | - Bernhard Dorweiler
- Department of Vascular Surgery, University Medical Center Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jörg Franke
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-University of Erlangen-Nuremberg, Egerlandstr. 7-9, 91058, Erlangen, Germany
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25
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Clifton W, Damon A, Valero-Moreno F, Nottmeier E, Pichelmann M. The SpineBox: A Freely Available, Open-access, 3D-printed Simulator Design for Lumbar Pedicle Screw Placement. Cureus 2020; 12:e7738. [PMID: 32455058 PMCID: PMC7241219 DOI: 10.7759/cureus.7738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The recent COVID-19 pandemic has demonstrated the need for innovation in cost-effective and easily produced surgical simulations for trainee education that are not limited by physical confines of location. This can be accomplished with the use of desktop three-dimensional (3D) printing technology. This study describes the creation of a low-cost and open-access simulation for anatomical learning and pedicle screw placement in the lumbar spine, which is termed the SpineBox. Materials and methods An anonymized CT scan of the lumbar spine was obtained and converted into 3D software files of the L1-L5 vertebral bodies. A computer-assisted design (CAD) software was used to assemble the vertebral models into a simulator unit in anatomical order to produce an easily prototyped simulator. The printed simulator was layered with foam in order to replicate soft tissue structures. The models were instrumented with pedicle screws using standard operative technique and examined under fluoroscopy. Results Ten SpineBoxes were created using a single desktop 3D printer, with accurate replication of the cortico-cancellous interface using previously validated techniques. The models were able to be instrumented with pedicle screws successfully and demonstrated quality representation of bony structures under fluoroscopy. The total cost of model production was under $10. Conclusion The SpineBox represents the first open-access simulator for the instruction of spinal anatomy and pedicle screw placement. This study aims to provide institutions across the world with an economical and feasible means of spine surgical simulation for neurosurgical trainees and to encourage other rapid prototyping laboratories to investigate innovative means of creating educational surgical platforms in the modern era.
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Affiliation(s)
| | - Aaron Damon
- Neurological Surgery, Mayo Clinic, Jacksonville, USA
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26
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Clarke J, Gillingwater T, Graham A, Milz S. Journal of Anatomy January 2020. J Anat 2019; 236:1-2. [PMID: 31823389 DOI: 10.1111/joa.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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27
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Barbaro F, Consolini E, Toscani G, Zini N, Dallatana D, Setti P, Mosca S, Di Conza G, Bassi E, Quarantini E, Quarantini M, Raposio E, Gorreri M, Porro A, Toni R. The masks of Lorenzo Tenchini: their anatomy and surgical/bioengineering clues. J Anat 2019; 235:1036-1044. [PMID: 31637719 DOI: 10.1111/joa.13069] [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: 07/08/2019] [Indexed: 12/01/2022] Open
Abstract
An academic, anatomist, and Lombrosian psychiatrist active at the University of Parma in Italy at the end of the 19th century, Lorenzo Tenchini produced ceroplastic-like masks that are unique in the anatomical Western context. These were prepared from 1885 to 1893 with the aim of 'cataloguing' the behaviour of prison inmates and psychiatric patients based on their facial surface anatomy. Due to the lack of any reference to the procedure used to prepare the masks, studies were undertaken by our group using X-ray scans, infrared spectroscopy, bioptic sampling, and microscopy analysis of the mask constituents. Results showed that the masks were stratified structures including plaster, cotton gauze/human epidermis, and wax, leading to a fabrication procedure reminiscent of 'additive layer manufacturing'. Differences in the depths of these layers were observed in relation to the facial contours, suggesting an attempt to reproduce, at least partially, the three-dimensional features of the facial soft tissues. We conclude the Tenchini masks are the first historical antecedent of the experimental method for face reconstruction used in the early 2000s to test the feasibility of transferring a complete strip of face and scalp from a deceased donor to a living recipient, in preparation for a complete face transplant. In addition, the layering procedure adopted conceptually mimics that developed only in the late 20th century for computer-aided rapid prototyping, and recently applied to bioengineering with biomaterials for a number of human structures including parts of the skull and face. Finally, the masks are a relevant example of mixed ceroplastic-cutaneous preparations in the history of anatomical research for clinical purposes.
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Affiliation(s)
- Fulvio Barbaro
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Elia Consolini
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Giulia Toscani
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Nicoletta Zini
- CNR - National Research Council of Italy, Institute of Molecular Genetics, Sezione di Bologna, Bologna, Italy.,IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Dallatana
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Pietro Setti
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Salvatore Mosca
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Giusy Di Conza
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | - Elena Bassi
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy
| | | | - Marco Quarantini
- Medical Center Galliera (CMG), San Venanzio di Galliera (BO), Italy
| | - Edoardo Raposio
- Chair of Plastic Surgery, DIMEC, University of Parma, Parma, Italy
| | - Marina Gorreri
- University of Parma Museum Network (Sistema Museale d'Ateneo), Parma, Italy
| | - Alessandro Porro
- Chair for the History of Medicine, University of Milan, Milan, Italy
| | - Roberto Toni
- Department of Medicine and Surgery - DIMEC, Unit of Biomedical, Biotechnological and Translational Sciences (S.BI.BI.T.), Section of Human Anatomy, Laboratory of Regenerative Morphology and Bioartificial Structures (Re.Mo.Bio.S.), and Museum and Historical Library of Biomedicine - BIOMED, University of Parma, Parma, Italy.,Medical Center Galliera (CMG), San Venanzio di Galliera (BO), Italy.,Interdepartment Center for Sport and Exercise Medicine, University of Parma, Parma, Italy.,Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Tufts Medical Center - Tufts University School of Medicine, Boston, MA, USA
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28
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Nagassa RG, McMenamin PG, Adams JW, Quayle MR, Rosenfeld JV. Advanced 3D printed model of middle cerebral artery aneurysms for neurosurgery simulation. 3D Print Med 2019; 5:11. [PMID: 31372773 PMCID: PMC6743137 DOI: 10.1186/s41205-019-0048-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/12/2019] [Indexed: 11/11/2022] Open
Abstract
Background Neurosurgical residents are finding it more difficult to obtain experience as the primary operator in aneurysm surgery. The present study aimed to replicate patient-derived cranial anatomy, pathology and human tissue properties relevant to cerebral aneurysm intervention through 3D printing and 3D print-driven casting techniques. The final simulator was designed to provide accurate simulation of a human head with a middle cerebral artery (MCA) aneurysm. Methods This study utilized living human and cadaver-derived medical imaging data including CT angiography and MRI scans. Computer-aided design (CAD) models and pre-existing computational 3D models were also incorporated in the development of the simulator. The design was based on including anatomical components vital to the surgery of MCA aneurysms while focusing on reproducibility, adaptability and functionality of the simulator. Various methods of 3D printing were utilized for the direct development of anatomical replicas and moulds for casting components that optimized the bio-mimicry and mechanical properties of human tissues. Synthetic materials including various types of silicone and ballistics gelatin were cast in these moulds. A novel technique utilizing water-soluble wax and silicone was used to establish hollow patient-derived cerebrovascular models. Results A patient-derived 3D aneurysm model was constructed for a MCA aneurysm. Multiple cerebral aneurysm models, patient-derived and CAD, were replicated as hollow high-fidelity models. The final assembled simulator integrated six anatomical components relevant to the treatment of cerebral aneurysms of the Circle of Willis in the left cerebral hemisphere. These included models of the cerebral vasculature, cranial nerves, brain, meninges, skull and skin. The cerebral circulation was modeled through the patient-derived vasculature within the brain model. Linear and volumetric measurements of specific physical modular components were repeated, averaged and compared to the original 3D meshes generated from the medical imaging data. Calculation of the concordance correlation coefficient (ρc: 90.2%–99.0%) and percentage difference (≤0.4%) confirmed the accuracy of the models. Conclusions A multi-disciplinary approach involving 3D printing and casting techniques was used to successfully construct a multi-component cerebral aneurysm surgery simulator. Further study is planned to demonstrate the educational value of the proposed simulator for neurosurgery residents.
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Affiliation(s)
- Ruth G Nagassa
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia.
| | - Paul G McMenamin
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - Justin W Adams
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - Michelle R Quayle
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, Australia
| | - Jeffrey V Rosenfeld
- Monash Institute of Medical Engineering, Monash University, Clayton, VIC, Australia.,Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia.,Department of Surgery, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
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29
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Personalized Three-Dimensional Printed Models in Congenital Heart Disease. J Clin Med 2019; 8:jcm8040522. [PMID: 30995803 PMCID: PMC6517984 DOI: 10.3390/jcm8040522] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/24/2022] Open
Abstract
Patient-specific three-dimensional (3D) printed models have been increasingly used in cardiology and cardiac surgery, in particular, showing great value in the domain of congenital heart disease (CHD). CHD is characterized by complex cardiac anomalies with disease variations between individuals; thus, it is difficult to obtain comprehensive spatial conceptualization of the cardiac structures based on the current imaging visualizations. 3D printed models derived from patient's cardiac imaging data overcome this limitation by creating personalized 3D heart models, which not only improve spatial visualization, but also assist preoperative planning and simulation of cardiac procedures, serve as a useful tool in medical education and training, and improve doctor-patient communication. This review article provides an overall view of the clinical applications and usefulness of 3D printed models in CHD. Current limitations and future research directions of 3D printed heart models are highlighted.
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