China: Establishing Validity of 3D Printing in Pre-Planning for Early-Stage Lung Cancer Procedures

Researchers from China are exploring the feasibility of 3D printing for pre-planning of complex surgeries, detailing the results of their study, involving the data of 124 patients, in the recently published ‘Three-dimensional printing in the preoperative planning of thoracoscopic pulmonary segmentectomy.’

The overall goal of the study was to compare 3D printing in pre-operative care to three-dimensional computed tomography (3D-CT) in thoracoscopic pulmonary segmentectomy. These procedures are meant to treat early-stage lung cancer and are expected to be used even more in the future to eradicate lung cancer caught in the beginning stages.

The lung segment is much more complex than the pulmonary lobe, leaving surgeons to seek out better techniques for seeing the anatomy involved as well as guiding the surgery. The lobectomy is still the traditional method of choice, however, and using the pulmonary segmentectomy as treatment is considered controversial by some. Such a procedure also requires greater skill in the operating room, as well as more experience in navigating surgery of the lung segment. Without comprehensively distinguishing the structure of the pulmonary segment before operating, the authors state that injuries are likely to be caused.

“Three-dimensional computed tomography (3D-CT) can well reconstruct the 3D images of vessels, bronchi, and tumor of the patient’s diseased pulmonary lobe and now is widely used to make a preoperative plan,” state the researchers. “However, 3D-CT still shows 3D images on 2D screens, which still has great limitations in viewing the anatomy of pulmonary vessels and bronchi.”

Patients were divided into three groups for the study: General, 3D-CT, and 3D printing. Pre-operative 3D image reconstruction was performed to view and reconstruct 3D images of the nodules, bronchi, and pulmonary vessels. The models were then printed on a Lite600HD 3D printer.

Photos from thoracoscopic LS6 segmentectomy. (A) Reconstructing 3D-CT image for LS6 segmentectomy; (B) pulmonary artery of LS6; (C) bronchus of LS6; (D) pulmonary vein of LS6.

As the actual surgery progressed, the patients received general anesthesia. Two to three incisions were made during the procedure, with camera ports in place. On point with the 3D-CT image or 3D printing model, the authors noted that ‘the arteries and veins of the target segment were found carefully during the operation.’

Photos from thoracoscopic RS9 segmentectomy. (A) 3D printed model of vessels and bronchi of the right lobe; (B) 3D printed model of arteries, veins, and bronchi of the right low lobe; (C) pulmonary arteries of RS9; (D) pulmonary arteries of RS9; (E) pulmonary vein of RS9; (F) bronchus of RS9. RPA, right pulmonary artery; RPB, right pulmonary bronchus; RPV, right pulmonary vein.

Highlights from the study showed the following:

• Intraoperative blood loss in 3D-CT group and 3D printing group decreased significantly
• Operation time in 3D-CT group and 3D printing group was significantly shorter than in the general group
• Differences in operation time for general group were significantly longer

*, general group and 3D-CT group; #, general group, and 3D printing group; **, 3D-CT group and 3D printing group.

One patient (from the 3D-CT group) experienced intraoperative injury, requiring thoracotomy; however, the researchers point out there was no conversion necessary in the 3D printing group.

“The incidence of postoperative hemoptysis in the general group occurred higher than in the 3D-CT group and 3D printing group, but the differences were not statistically significant (P>0.05), we believed that the intersegmental veins were confirmed preoperatively through 3D-CT images and 3D printing models, and intraoperative protection was paid to avoid injury, and then the incidence of postoperative hemoptysis was reduced.

“In conclusion, this study shows that 3D-CT and 3D printing for making preoperative plan have an equivalent effect in thoracoscopic pulmonary segmentectomy for experienced surgeons. Preoperative simulations using 3D printing for the assessment of pulmonary vessels and bronchi branching patterns is beneficial for the safe and efficient performance of thoracoscopic pulmonary segmentectomy. Although it takes longer to create a 3D printed model and costs more, 3D printing is an especially useful tool for thoracic surgery,” concluded the researchers.

3D printing is being used by surgeons around the world for numerous applications; however, the ability to plan more comprehensively for surgeries is a huge advantage, whether in treating lung cancer, performing surgeries for hip fractures, pediatric orthopedics, shoulder surgeries, and more.