Value proposition of patient-specific 3D-printed models

[petomed]

If you could elect to receive a 3D-printed replica of your patient's specific anatomy throughout the entirety of the operative field within 24-hours after their standard pre-operative imaging, would you? If so, how would you go about attaching a dollar value to it? If not, what are your reservations?

This tech is assumed to have already been through the peer-review publication process and also assumed to be at least as robust and reliable as the standard imaging technologies practitioners already use today.

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[Wordead]

What would be the purpose? I would only see value if you can print each part of the field in a different material that replicates muscle, bone, nerves, etc and that each component can be moved and even then it sounds pretty useless to me.

This is already done for some things where it's useful - bone defects so plates can be bent or pre-made. I dont see the use for the whole operative field.

 

[petomed]

What would be the purpose? I would only see value if you can print each part of the field in a different material that replicates muscle, bone, nerves, etc and that each component can be moved and even then it sounds pretty useless to me.

This is already done for some things where it's useful - bone defects so plates can be bent or pre-made. I dont see the use for the whole operative field.

Improved outcomes and/or improved throughput would be the purpose.

I imagine there would be no extrinsic value added for situations that are routine or for those that are obvious as to whether or not you're willing to open the person up based on the already available data. Perhaps the ability to manipulate the anatomy, rapidly retract and excise, and generate margins of interest within the scope of an error-free environment--would offer insights on those grey cases that could influence whether or not the surgeon accepts a case they would otherwise not consider. Even so, following this line of thought, one would need to weigh the time spent manipulating the model + the money spent on the model against time operating on other cases in order to derive a net extrinsic value added, if it even exists.

As you mentioned, reasonably accurate material properties like density and elasticity of the various tissues would be important for the model to have life-like feel.

As for the whole operative field, I think it's important to be able to capture these details. But it shouldn't be included in the model if it isn't determined to be necessary.

In essence, the sentiment would be to make less frequent a surgeon thinking things like "Had I known A and B ahead of time, I would've done C and D during surgery instead." If there's never an ability to think such thoughts, then pre-operative technology is as good today as it will ever be.

 

[HighPriest]

I think it would be academically interesting but not particularly useful. I assume you would be generating a 3D printed model from an imaging source (CT or MRI). The problem is the limitations of CT and MRI with regards to resolution. I feel like, after years of looking at imaging, that I can look at a scan and build a mental image of what I’m going to run in to, even in complex or revision cases. When something surprises me it usually isn’t something that was on the scan, but I missed it or didn’t incorporate it into my mental plan. It’s usually because it was something that was not visible in the scan or not clearly resolved in the scan. I’m not sure how a printed image would have a higher resolution than the scan from which it is generated.

The one exception might be certain complex or revision sinus cases, where the 3D anatomy can be complex or misleading intraoperatively - especially when you’re learning to operate. It would probably be a great tool for resident teaching. But, again, the issue is usually with (for example) polyploid disease where the scan just shows a bunch of diffuse, gray schmutz filling everything. I’m not sure how you would make that anything like the real thing.

 

[DoctwoB]

Same thoughts here. It’s neat, can be a fun tool to show patients to help them visualize the surgery, but of limited surgical utility except in perhaps edge cases. I certainly would not expect any difference in outcomes, and am suspicious of literature to the contrary as by definition it can’t be a blinded trial.

The real utility IMO comes in surgical training. If we can get the hydrogel “tissues” to more closely represent human tissue then that provides a better platform for trainees to practice on, especially on the robot where learning tissue manipulation is essential yet difficult.

 

[Lem0nz]

If you could elect to receive a 3D-printed replica of your patient's specific anatomy throughout the entirety of the operative field within 24-hours after their standard pre-operative imaging, would you? If so, how would you go about attaching a dollar value to it? If not, what are your reservations?

This tech is assumed to have already been through the peer-review publication process and also assumed to be at least as robust and reliable as the standard imaging technologies practitioners already use today.

We have that ability at my institution. They've done high res 3D printed anatomical models for liver/pancreas for the last surgeon. As others have said, knowing I have the ability to do this I have found no practical application for it. It doesn't change the ability to do the operation and there is not material that can mimic tissue planes to 'practice' on.

Even if there were, at the end of the day, there is simply not time. What you're proposing would be of use in only highly technical and challenging operations and those operations take 5+ hours and sometimes many many more. Very few surgeons have enough time in the day to do that twice, with no reimbursement, just to make sure the second one on the live person goes well.

 

[TypeADissection]

Super late to the party - but having had this tech in fellowship for complex aorta; it wasn't that helpful. The reality is, CTA is so good combined with the centerline software we already have; I don't see the real added bonus of this tech. We used it twice I think for some combo cases w/ CTS where we were gonna have to do some arch reconstruction w/ descending thoracic work but that's more for them and less for me. Anyway, all that to say that I didn't see a huge need for it then and even less now in practice. I guess I could maybe see the application in esoteric fields like Pediatric CTS where babies have very non-routine and anomalous anatomy, but otherwise it's a big meh for me dawg. Cheers.

 

[dienekes88]

If you could elect to receive a 3D-printed replica of your patient's specific anatomy throughout the entirety of the operative field within 24-hours after their standard pre-operative imaging, would you? If so, how would you go about attaching a dollar value to it? If not, what are your reservations?

This tech is assumed to have already been through the peer-review publication process and also assumed to be at least as robust and reliable as the standard imaging technologies practitioners already use today.

This could be helpful for complex septations in congenital heart surgery. 2d imaging doesn't always do a great job of representing the anatomy.

 

[petomed]

I appreciate the feedback.