Page 163 - IJB-9-6

International Journal of Bioprinting 3D printing in gastroenterology

organ-specifically and modularly. The highlight of the repair (IHR) . Four years later, they used this TAPP model
[32]
model is that different organs were printed and filled with to evaluate surgeons’ skills preoperatively and found that
different materials that mimicked radiological density in the model could distinguish surgeons with different levels
real CT scans, like water, liquid urethane rubber, agar-based of laparoscopic IHR experience . A similar outcome of
[45]
solution, etc. The model could be scanned using CT, and the the laparoscopic choledochojejunostomy model was
image was comparable to that of real human bodies. This reported by Xia et al. based on the Objective Structured
model is particularly useful in anatomical and radiological Assessment of Technical Skills (OSATS) scoring system .
[46]
courses for medical students for better correlation between Therefore, patient-specific 3DP models might be added to
anatomy and radiology. Similar demonstrations using 3D medical curricula for both education and evaluation. The
models for situs ambiguus of gastrointestinal organs , 3DP model is more beneficial to less experienced residents
[36]
superior mesenteric artery plexus , and liver segments and students rather than experts. The educative effect is
[38]
[37]
were also documented. particularly good among medical interns in understanding
complex GI structures like Henle’s trunk , practicing
[47]
The 3DP model is patient-friendly tool for suturing , and perceiving oncopathological anatomy
[48]
communicating the medical-related information as well as in different scenarios . Quantitative analysis revealed
[49]
facilitating the consent acquisition process. Almost all the that both surgeons and patients recognized 3DP models
cases reported above acknowledged that the printed model as useful, authentic, and favorable and scored median
had positive effect on doctor–patient communication, to high in preoperative planning, promoting learning,
patient’s understanding of the operation’s necessity, helping patients, and making effective and less conflicting
procedure, and expected difficulties or complications, decisions [7,50] . Surgical plans made upon 3DP models usually
and helped family members have realistic expectations. have a higher consistency with intraoperative findings .
[51]
For postoperative care education, the model shows some
benefits. For example, patient-specific postcolectomy The 3DP model is most useful in low-volume medical
stoma care training using a life-size printed model is helpful centers where rare and complex cases are hardly seen.
for patients to understand and reduce skin problems after While we have seen its many benefits, there remain
self-practicing on the model . problems to be solved: (i) Printing cost is high and time
[39]
is long, and sometimes reprint is needed because of low
The above studies are mainly presented as case reports, quality ; (ii) Few comparisons are designed (traditional
[42]
the conclusions of which were not validated . A pilot study surgery vs. 3DP, 3DP vs. virtual reality); (iii) Evaluation
[40]
focusing on laparoscopic splenectomy enrolled 12 patients criteria are mostly subjective; (iv) Sample size is too small
and 10 surgical residents, and both patients and residents to yield convincing result. A summary of the above-
highly confirmed the better illustrative and educative effects mentioned applications is listed in Table 1.
of 3DP models . Luzon et al. included 23 patients and
[41]
confirmed that the patient-specific 3DP model was useful in
right colectomy and D3 mesenterectomy . The accuracy 2.3. Accessory production
[42]
of interanatomical structural distance measurement was Apart from printing models for planning and education,
validated by comparison with virtual 3D and intraoperative printing-customized 3D tools might also be promising.
measurements. However, no clinical outcomes pertaining Steinemann et al. tried to produce a space holder using
to surgery, e.g., time, blood loss, complications, hospital 3DP to facilitate an intra-esophageal mucosal purse-string
[52]
stay, cost, and prognosis, were included in these studies. suture in Barrett’s esophagus . They found that the space
In a prospective study, researchers from China found that holder helped resect more mucosa on sacrificed pigs but
3DP models could help reduce the operation time (average increased operational time and stitching variance. Another
39.2 min), bleeding volume (average 45.1 ml), and medical animal experiment of minipigs conducted by Yang et al.
expense (6.74%) while increasing rates of lymph node tested the usefulness of a 3DP biopolymer device in
[53]
dissection (average 3.3) and patient satisfaction in right duct-to-mucosa pancreaticojejunostomy . After 24
hemicolon cancer surgery . Hojo et al. also reported a weeks of observation, they concluded that the device
[43]
greater number of pelvic lymph nodes dissected for rectal was promising for pancreatoenteric reconstruction with
cancer in the 3DP group, using a retrospective propensity feasible procedural time and no adverse events. However,
score matching method . further controlled studies are warranted for validation.
[44]
One special design might be the PLAFOKON operating
In addition to education, there is also research platform, a flexible 3DP single-port overtube that was
concerning preoperative skill evaluation. Nishihara et al. intervention-specific for individuals . Other 3DP objects
[54]
previously constructed a 3DP model for the simulation include spiral polymer stent for malignant esophageal
of transabdominal preperitoneal (TAPP) inguinal hernia stenosis , enteroatmospheric fistula tent [56,57] , gastric
[55]

Volume 9 Issue 6 (2023) 155 https://doi.org/10.36922/ijb.0149