2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, 31-501, Krakow, Poland.
Center for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.
Eur Radiol. 2020 Mar;30(3):1306-1312. doi: 10.1007/s00330-019-06511-2. Epub 2019 Nov 26.
The aim of this study was to evaluate impact of 3D printed models on decision-making in context of laparoscopic liver resections (LLR) performed with intraoperative ultrasound (IOUS) guidance.
Nineteen patients with liver malignances (74% were colorectal cancer metastases) were prospectively qualified for LLR or radiofrequency ablation in a single center from April 2017 to December 2018. Models were 3DP in all cases based on CT and facilitated optical visualization of tumors' relationships with portal and hepatic veins. Planned surgical extent and its changes were tracked after CT analysis and 3D model inspection, as well as intraoperatively using IOUS.
Nineteen patients were included in the analysis. Information from either 3DP or IOUS led to changes in the planned surgical approach in 13/19 (68%) patients. In 5/19 (26%) patients, the 3DP model altered the plan of the surgery preoperatively. In 4/19 (21%) patients, 3DP independently changed the approach. In one patient, IOUS modified the plan post-3DP. In 8/19 (42%) patients, 3DP model did not change the approach, whereas IOUS did. In total, IOUS altered surgical plans in 9 (47%) cases. Most of those changes (6/9; 67%) were caused by detection of additional lesions not visible on CT and 3DP.
3DP can be helpful in planning complex and major LLRs and led to changes in surgical approach in 26.3% (5/19 patients) in our series. 3DP may serve as a useful adjunct to IOUS.
• 3D printing can help in decision-making before major and complex resections in patients with liver cancer. • In 5/19 patients, 3D printed model altered surgical plan preoperatively. • Most surgical plan changes based on intraoperative ultrasonography were caused by detection of additional lesions not visible on CT and 3D model.
本研究旨在评估在术中超声（IOUS）引导下进行腹腔镜肝切除术（LLR）的情况下，3D 打印模型对决策的影响。
2017 年 4 月至 2018 年 12 月，在一家单中心前瞻性地将 19 例患有肝癌（74%为结直肠癌转移）的患者纳入 LLR 或射频消融治疗的适应证。所有病例均基于 CT 进行 3DP，并有助于可视化肿瘤与门静脉和肝静脉的关系。在 CT 分析和 3D 模型检查后以及术中使用 IOUS 跟踪计划的手术范围及其变化。
19 例患者纳入分析。3DP 或 IOUS 的信息导致 19 例患者中的 13 例（68%）改变了计划的手术方法。在 5 例（26%）患者中，3DP 模型在术前改变了手术计划。在 4 例（21%）患者中，3DP 独立改变了方法。在 1 例患者中，IOUS 在 3DP 后修改了计划。在 8 例（42%）患者中，3DP 模型未改变方法，而 IOUS 改变了方法。总的来说，IOUS 改变了 9 例（47%）患者的手术计划。这些变化中的大多数（6/9；67%）是由于检测到 CT 和 3DP 均未显示的附加病变引起的。
3DP 可用于规划复杂和重大的 LLR，并导致我们系列中 26.3%（5/19 例患者）的手术方法发生改变。3DP 可以作为 IOUS 的有用辅助手段。
3D 打印可帮助决策在具有肝癌的患者进行重大和复杂切除之前。
在 5 例患者中，3D 打印模型术前改变了手术计划。
基于术中超声的大多数手术计划变化是由于检测到 CT 和 3D 模型均未显示的附加病变引起的。
