Department of General, Visceral, and Transplantation Surgery, University Medical Center Mainz, Mainz, Germany.
Ann Surg. 2021 Jan 1;273(1):e26-e27. doi: 10.1097/SLA.0000000000004348.
We present a series of cases where we used 3D printing in planning of complex liver surgery.
In liver surgery, three-dimensional reconstruction of the liver anatomy, in particular of vascular structures, has shown to be helpful in operation planning. So far, 3D printing has been used for medical applications only rarely.
From December 2017 to December 2019, in 10 cases where surgery was assumed to be challenging operation planning was performed using full size 3D prints in addition to standard 3 phase CT scans. Models included transparent parenchyma, hepatic veins, vena cava, portal vein, hepatic artery, (biliary tree if requested), and tumors. In 7/10 cases vascular reconstructions were needed during the procedure. Nonstructured feedback of the surgical team revealed that the major benefit was visualization of the critical areas of vascular reconstruction, the expected dimensions of tangential vascular infiltration and the planning of reconstruction. In the multifocal tumors, 3D prints were considered to be helpful for intraoperative orientation to detect metastases and to improve planning of the resection.
In complex liver surgery with potential need for vascular reconstructions operation planning may be optimized using a 3D printed liver model. Prospective studies are needed to evaluate the clinical impact of 3D printing in liver surgery compared to other 3D visualizations.
我们展示了一系列使用 3D 打印技术进行复杂肝脏手术规划的病例。
在肝脏手术中，肝脏解剖结构的三维重建，特别是血管结构的重建，已被证明有助于手术规划。到目前为止，3D 打印仅在医学应用中很少使用。
从 2017 年 12 月至 2019 年 12 月，在 10 例手术难度较大的情况下，除了标准的三期 CT 扫描外，还使用全尺寸 3D 打印进行手术规划。模型包括透明实质、肝静脉、腔静脉、门静脉、肝动脉、（如有需要胆道树）和肿瘤。在 7/10 的病例中，术中需要进行血管重建。手术团队的非结构化反馈表明，主要的益处是可视化血管重建的关键区域、预计的切线血管浸润的尺寸以及重建的规划。在多灶性肿瘤中，3D 打印被认为有助于术中定位以发现转移灶并改善切除规划。
在需要血管重建的复杂肝脏手术中，使用 3D 打印的肝脏模型可以优化手术规划。需要前瞻性研究来评估 3D 打印在肝脏手术中与其他 3D 可视化相比的临床影响。
