Application of 3D modeling and printing technology in accurate resection of complicated thoracic tumors

The role of 3D printing in chest wall reconstruction

Technology is advancing fast, and chest wall surgery finds particular benefit in the broader availability of three-dimensional (3D) reconstruction and printing. An increasing number of reports are being published on the use of these resources in virtual 3D reconstructions of chest walls in computed tomography (CT) scans, virtual surgeries, 3D printing of real-size models for surgical planning, practice, and education, and of note, the manufacture of customized 3D printed implants, changing the fundamental conception from a surgery that fits all, to a surgery for each patient. In this review, we explore the evidence published on simple chest wall reconstruction, including the use of 3D technology to assist in the improvement of the repair of the most frequent chest wall deformities: pectus excavatum and carinatum. Current studies are oriented to the automatization and customization of transthoracic implants, as well as education on real-size models. Next, we investigate the implementation of 3D printing in the repair of complex chest wall reconstruction, comprised of infrequent chest wall deformities such as pectus arcuatum and Poland syndrome. These malformations are very heterogeneous resulting in a high degree of improvisation during the surgical repair. In this setting, 3D technology plays a role in the standardization of a process that contemplates customization, concepts that may seem contradictory. Finally, 3D printing with biocompatible materials is rapidly becoming the first choice for the reconstruction of wide chest wall oncological resections. In this work, we review the first and most important current publications on the subject.

Application of preoperative 3D printing in the internal fixation of posterior rib fractures with embracing device: a cohort study

BACKGROUND

To explore the impact of preoperative 3D printing on the fixation of posterior rib fractures utilizing a memory alloy embracing device of rib under thoracoscopy.

METHODS

The enrolled patients were divided into the 3D printing (11 patients) and the non-3D printing (18 patients) groups, based on whether a 3D model of ribs was prepared prior to surgery. Analysis was conducted comparing the average fixation time per fracture, postoperative fixation loss, and poor reduction of fractured end between the two groups.

RESULTS

The average fixation time of each fracture was 27.2 ± 7.7 min in the 3D printing group and 29.3 ± 8.2 min in the non-3D printing group, with no statistically significant difference observed between the two groups (P > 0.05). The incidence of poor fracture fixation in the 3D printing group was statistically lower than that in the non-3D printing group (12.9% vs. 44.7%, P < 0.05). Further stratified analysis revealed that the off-plate rate in the 3D printing group and the non-3D group was (3.2% vs. 12.8%, P > 0.05), and the dislocation rate of the fractured end was (9.7% vs. 31.9%, P < 0.05).

CONCLUSIONS

The application of 3D printing technology to prepare the rib model before surgery is proves beneficial in reducing the occurrence of poor fixation of fractures and achieving precise and individualized treatment.

Three-dimensional technologies in chest wall resection and reconstruction

Resection and reconstruction of the chest wall can pose unique challenges given its vital role in the protection of the thoracic viscera and the dynamic part it plays in respiration. A number of new three-dimensional (3D) technologies may be invaluable in tackling these challenges. Herein we review the use of 3D technologies in preoperative imaging with virtual 3D models, printing of 3D models for preoperative planning, and printing of 3D prostheses when approaching complex chest wall reconstruction.

Risk assessment of severe postpartum hemorrhage after invasive placenta accreta based on three-dimensional reconstruction of magnetic resonance imaging

Background

The aim of this study was to investigate the significance and feasibility of risk assessments based on the three-dimensional (3D) reconstruction of magnetic resonance imaging (MRI) of invasive placenta accreta (IPA) to create individualized surgical protocols and perioperative management plans in late pregnancy.

Methods

MRI and clinical data of 36 pregnant women with IPA admitted to Southwest Hospital from January 2017 to June 2021 were retrospectively analyzed. The patients were divided into the following 4 groups: peripartum hysterectomy (PH), abdominal aortic balloon block (AABB), PH with AABB, and nonsurgical treatment. Each group was then divided into severe and nonsevere postpartum hemorrhage subgroups based on postpartum hemorrhage volumes of not more than 2,000 mL and more than 2,000 mL, respectively. The uteri, placentas, IPA, and urinary bladders in each group were segmented and 3-dimensionally reconstructed using Amira 5.2.2 (Visage Imaging, Richmond, Australia) software, and their surface areas and volumes were calculated. A multifactorial unconditional logistic regression analysis was performed to evaluate the 3D morphological parameters of postpartum hemorrhage and calculate the optimal threshold.

Results

The bleeding volume, IPA area, placental area:uterine area ratio, IPA area:placental area ratio, maximum depth of IPA, placental position score, IPA position score, and implantation volume were greater in the severe postpartum hemorrhage subgroup than in the nonsevere postpartum hemorrhage subgroup of all groups. In the multifactorial regression analysis, the areas under the receiver operating characteristic curve of the implantation area, implantation volume, maximum depth of implantation, and implantation area:placental area ratio exceeded 0.9 and correlated strongly with severe postpartum hemorrhage, while those of the uterine area, uterine volume, placental area, placental volume, and placental area:uterine area ratio were between 0.5 and 0.7 and correlated with severe postpartum hemorrhage. The threshold (cutoff values) determining severe postpartum hemorrhage were 20,286.25 mm² of the implantation area, 0.01271 of the implantation area:placental area ratio, 15.03 mm of the maximum depth of implantation, and 46,846 mm³ of the implantation volume.

Conclusions

The MRI 3D reconstruction of IPA and its adjacent structures can accurately display the location, anatomical morphology, and spatial relationship of IPA, which can be used to improve the accuracy of IPA diagnosis, predict postpartum hemorrhage, and provide optimized treatment decisions for obstetricians.

Application Research of Three-Dimensional Printing Technology and Three-Dimensional Computed Tomography in Segmentectomy

Background

To compare the application of the emerging 3D printing technology and 3D-CT in segmentectomy. And to explore the advantages of 3D printing technology in thoracoscopic segmentectomy.

Methods

We collected the clinical data of 118 patients undergoing thoracoscopic segmentectomy from January 2019 to April 2021 at the Thoracic Surgery Department, the Dianjiang People's Hospital of Chongqing and Southwest Hospital. Among them, 61 patients were in the 3D printing group and 57 patients were in the 3D-CT group respectively. The perioperative data of these two groups of patients were analyzed respectively.

Results

There were no significant differences between the two groups in age, gender, tumor diameter, pathology, the preoperative complications of diabetes and heart disease. However, the patients with the complications of hypertension in the 3D printing group are significantly more than the 3D-CT group (P = 0.003). Compared with the 3D-CT group, patients in the 3D printing group had significantly shorter operation time (162.7 ± 47.0 vs. 190.3 ± 56.9 min, P = 0.006), less intraoperative fluid input (1,158.5 ± 290.2 vs. 1,433.2 ± 653.3, P = 0.013), and less total intraoperative fluid output, including intraoperative blood loss, urine excretion, and other fluid loss. In addition, there were no statistically significant differences in intraoperative blood loss, 24 h pleural fluid volume, 48 h pleural fluid volume, postoperative chest tube duration, postoperative hospital stay and complications between the two groups of patients (P &gt; 0.05).

Conclusions

In thoracoscopic segmentectomy, the application of 3D printing technology shortens the operation time, reduces intraoperative fluid input and output, guides the operation more safely and effectively, and has better clinical application value.