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RESEARCH ARTICLE

3D Printing Model of Abdominal Cavity of Liver

Transplantation Recipient to Prevent Large-for-Size

Syndrome

Sunghae Park, Gyu-Seong Choi, Jong Man Kim, Sanghoon Lee, Jae-Won Joh, Jinsoo Rhu*

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Abstract: The application of three-dimensional (3D) printing has been increasing and we invented cost-effective and time-
saving 3D printed model of intra-abdominal cavity which was utilized in liver transplantation (LT) to prevent large-for-size
syndrome. 3D printings were performed on potential adult recipients with small cavity and pediatric patients scheduled for
transplantation during July 2020 – September 2021. Based on the computed tomography of the recipient, the inner surface of
the abdominal cavity was outlined. The line was marked with a distance of 1 – 3 cm. Then, the outlined data were reconstructed
as a 3D model and printed by a fused deposition modeling type 3D printer with a thickness of 2 mm. Pillars and footings for
holding the lines were printed and assembled altogether. During deceased donor organ procurement, the size of the graft was
compared to that of the printed model. For living donor LT, preoperatively planned liver graft was printed and was physically
placed into the 3D printed abdominal cavity. All the 16 cases with 3D printed abdominal cavity showed appropriate fitting of
the donor’s liver graft to both the 3D printed model and actual recipient’s abdominal cavity with no large-for-size syndrome
after LT. Median time for manufacturing the model was 576 min (IQR 434 – 680) and estimated median cost for the filament
was US$ 1.6 (IQR 1.2 – 1.7). The 3D printed abdominal cavity model can be manufactured in <10 h and was useful for
preventing large-for-size syndrome in small-sized recipients.

Keywords: 3D printing; Large-for-size syndrome; Liver transplantation; 3D printer
*Correspondence to: Jinsoo Rhu, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-
dong, Gangnam-gu, Seoul 135-710, Korea; jsrrules@gmail.com

Received: May 19, 2022; Accepted: June 30, 2022; Published Online: August 24, 2022
Citation: Park S, Choi G, Kim JM, et al., 2022. 3D printing model of abdominal cavity of liver transplantation recipient to prevent large-for-
size syndrome. Int J Bioprint. 8(4):609. http://doi.org/10.18063/ijb.v8i4.609

1. Introduction anatomical structures including hepatic vasculatures
and bile ducts . Despite its benefits on enabling a better
[8]
Three-dimensional (3D) printing, also known as rapid anatomical understanding and more precise preoperative
prototyping or additive manufacturing, is one of the planning , 3D printing is expensive and time-consuming,
[9]
rapidly developing technologies. At present, diverse which limits commercialization of the technology.
techniques for 3D printing have been developed which During liver transplantation (LT), using large-sized
were outlined by the ISO/ASTM standard: Binder jetting, grafts may result in difficult abdominal closure as well
material jetting, material extrusion, powder bed fusion, as graft compression, followed by poor oxygen supply
directed energy deposition, sheet lamination, and vat and graft dysfunction . Large-for-size syndrome is not
[10]
photopolymerization [1-5] . The application of 3D printing common but can occur with fatal outcome in pediatric
has also been gradually increasing in the medical field due LT from living donors and in whole LT from deceased
to its potential as a personalized medical tool, especially donor in adults with small abdominal cavity. Therefore,
in maxillofacial and craniofacial surgery [6,7] . Recently, we created a 3D printed model of abdominal cavity of
patient-specific 3D models of liver were utilized to recipients based on the idea that large-for-size syndrome
investigate the relationship between liver tumors and could be prevented in advance through size comparison

© 2022 Author(s). This is an Open-Access article distributed under the terms of the Creative Commons Attribution License, permitting distribution and
reproduction in any medium, provided the original work is properly cited.
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