Three-Dimensional (3D) Printing in Surgical Pathology: The Design of a Novel Grossing Tool to Aid Staple Removal in Pulmonary Pathology Excision Specimens.

Pathologists or laboratory technicians who perform a gross examination of lung specimens may, under the pressure of performing a frozen section or in a less urgent setting when selecting permanent sections, encounter a specimen with a lesion close to a stapled surgical margin. Performing a perpendicular section from the lesion to the closest surgical margin is often necessary, and the technique of shaving the staple line from the specimen before sectioning may yield suboptimal results in margin assessment. It is widely accepted that staple removal is a tedious task, both time-consuming and, more importantly, with a high risk of damaging the stapled tissue and causing difficulty in its precise microscopic evaluation. With regard to three-dimensional (3D) printing, the emergence of software for 3D design, with easy-to-learn interfaces, available at no monetary cost, as well as the ability to have one's designs produced and delivered swiftly and at low cost through regional stores, has bridged the gap between conception and implementation of novel ideas in several sectors of medicine. A grossing tool was designed and 3D printed, with the aim of facilitating the procedure of staple removal by reducing the time required and the tissue damage caused. The tool was tested on test material created from synthetic sponges, with the goal of simulating the physical properties of lung parenchyma. The variables measured were time for removal per staple and estimated test material damage after removal of each staple. Two techniques for staple removal were used: the "pinch-and-pull" technique of vertically pulling the staple and the "push-through" technique of carefully lifting the staple by pushing the forceps perpendicularly underneath the staple. The results showed that the use of the tool is superior, with improvement for both variables in both techniques. Our report aims to showcase this novel grossing tool, present the approach to its creation, analyze relevant medical literature, and also highlight the ease of implementation and future prospects of 3D printed designs in medical education and practice.