Three-Dimensional Printing Applications in Thoracic Surgery.

Advances in technology allowing the combination of medical imaging and three-dimensional printing have greatly benefitted thoracic surgery, allowing for the creation of complex prostheses. Surgical education is also a significant application of three-dimensional printing, especially for the development of simulation-based training models. Aiming to show how three-dimensional printing can benefit patients and clinicians in thoracic surgery, an optimized method to create patient-specific chest wall prosthesis using three-dimensional printing was developed and clinically validated. An artificial chest simulator for surgical training was also developed, replicating the human anatomy with high realism and accurately simulating a minimally invasive lobectomy.

Development and Evaluation of a Rib Statistical Shape Model for Thoracic Surgery.

Patients with advanced cancer undergoing chest wall resection may require reconstruction. Currently, rib prostheses are created by segmenting computed tomography images, which is time-consuming and labour intensive. The aim was to optimise the production of digital rib models based on a patient's age, weight, height and gender. A statistical shape model of human ribs was created and used to synthetise rib models, which were compared to the ones produced by segmentation and mirroring. The segmentation took 11.56±1.60 min compared to 0.027 ±0.009 min using the new technique. The average mesh error between the mirroring technique and segmentation was 0.58±0.25 mm (right ribs), and 0.87±0.18 mm (left ribs), compared to 1.37±0.66 mm ( ) and 1.68 ±0.77 mm ( ), respectively, for the new technique. The new technique is promising for the efficiency and ease-of-use in the clinical environment. Clinical Relevance- This is an optimised 3D modelling method providing clinicians with a time-efficient technique to create patient-specific rib prostheses, without any expertise or software knowledge required.

Creation of personalised rib prostheses using a statistical shape model and 3D printing: Case report.

Management of chest wall defects after oncologic resection can be challenging, depending on the size and location of the defect, as well as the method of reconstruction. This report presents the first clinical case where patient-specific rib prostheses were created using a computer program and statistical shape model of human ribs. A 64-year-old male was diagnosed with non-small-cell lung cancer originating in the right upper lobe and invading the lateral aspect of the 3rd, 4th, and 5th ribs. Prior to surgical resection, a statistical shape model of human ribs was created and used to synthesise rib models in the software MATLAB (MathWorks, Natick, MA, USA). The patient's age, weight, height, and sex, as well as the number and side of the ribs of interest, were the inputs to the program. Based on these data, the program generated digital models of the right 3rd, 4th, and 5th ribs. These models were 3D printed, and a silicone mould was created from them. The patient subsequently underwent right upper lobectomy with en bloc resection of the involved chest wall. During the operation, the silicone mould was used to produce rigid prostheses consisting of methyl methacrylate and two layers of polypropylene mesh in a "sandwich" fashion. The prosthetic patch was then implanted to cover the chest wall defect. Thirty days after the surgery, the patient has returned to his pre-disease performance and physical activities. The statistical shape model and 3D printing is an optimised 3D modelling method that can provide clinicians with a time-efficient technique to create personalised rib prostheses, without any expertise or prior software knowledge.

Chest Wall Reconstruction Using 3-Dimensional Printing: Functional and Mechanical Results.

BACKGROUND: Tumors involving the chest wall may require extensive resection and reconstruction. This study aims to evaluate functional, cosmetic results, and quality of life (QoL) in patients who had a reconstruction based on patient-specific 3-dimensional (3D) printing. METHODS: The patient-specific chest wall prosthesis was created for 10 patients. The anatomical models were 3D printed and used to produce a silicone mold that was filled with methyl methacrylate to create the customized prosthesis. Evaluation of the reconstruction was completed with a QoL assessment and postoperative tracking of patients' chest motion, using infrared markers. The distance between plot points representing markers on the operated and contralateral sides was measured to assess symmetrical motion. RESULTS: Twenty-three consecutive patients were enrolled, with the median age of 64 years. Thirteen patients underwent a nonrigid reconstruction, and 10 had a patient-specific rigid reconstruction with methyl methacrylate. The median number of ribs resected was 3. No postoperative complications or morbidity related to the prostheses were reported. The median hospital stay in the nonrigid reconstruction group was 8.5 days compared with 7.5 days (p = .167) in the rigid reconstruction group. Postoperatively, most patients had low levels of symptoms, with 82% experiencing chest pain and 53% experiencing dyspnea. Rigid reconstruction patients demonstrated more symmetrical breathing motion compared with nonrigid reconstruction patients. The mean distances were 2.32 ± 2.18 and 7.28 ± 5.87 (P < .00001), respectively. CONCLUSIONS: This study shows that a 3D patient-specific prosthesis is feasible and safe, suggesting a possible trend toward improved breathing mechanics, QoL, and cosmetic results.

Simulation and Measurement of Aerosolisation in Different Chest Drainage Systems.

The aim of the study was to assess the degree of aerosolisation in different chest drainage systems according to different air leak volumes, in a simulated environment. This novel simulation model was designed to produce an air leak by passing air through and agitating a fluorescent fluid. The air leak volume and amount of fluorescent fluid were tested in various combinations and aerosolisation was assessed at 10-minute intervals using the ultraviolet light. The following chest drainage systems were compared: (1) single-chamber chest drainage system, (2) 3-compartment wet-dry suction chest drainage system, (3) digital drainage and monitoring system. The impact of suction (-2 and -4 kPa) in generating aerosolised particles was tested as well. A total number of 187 of 10-minute interval measurements were performed. The single-chamber chest drainage system generated the largest number of aerosolised particles at different air leak volumes and drainage output. The 3-compartment wet-dry suction system and the digital drainage and monitoring system did not generate any identifiable aerosolised particles at any of the air leak or drain output volumes considered. Suction applied to the chest drainage systems did not have an effect on aerosolisation. Aerosol generation in the simulated air-leak model demonstrated the potential risk of SARS-CoV-2 spread in the clinical setting. Full personal protective equipment must be used in patients with an air leak. Single-chamber chest drainage system generates the highest rate of aerosolised particles and it should not be used as an open system in patients with an air leak.

3D advanced imaging overlay with rapid registration in CHD to reduce radiation and assist cardiac catheterisation interventions.

Novel commercially available software has enabled registration of both CT and MRI images to rapidly fuse with X-ray fluoroscopic imaging. We describe our initial experience performing cardiac catheterisations with the guidance of 3D imaging overlay using the VesselNavigator system (Philips Healthcare, Best, NL). A total of 33 patients with CHD were included in our study. Demographic, advanced imaging, and catheterisation data were collected between 1 December, 2016 and 31 January, 2019. We report successful use of this technology in both diagnostic and interventional cases such as placing stents and percutaneous valves, performing angioplasties, occlusion of collaterals, and guidance for lymphatic interventions. In addition, radiation exposure was markedly decreased when comparing our 10-15-year-old coarctation of the aorta stent angioplasty cohort to cases without the use of overlay technology and the most recently published national radiation dose benchmarks. No complications were encountered due to the application of overlay technology. 3D CT or MRI overlay for CHD intervention with rapid registration is feasible and aids decisions regarding access and planned angiographic angles. Operators found intraprocedural overlay fusion registration using placed vessel guidewires to be more accurate than attempts using bony structures.

Three-Dimensional Printing for Chest Wall Reconstruction in Thoracic Surgery: Building on Experience.

OBJECTIVES: Patients undergoing surgery for locally advanced lung cancer involving the chest wall require anatomical lung with extensive en-bloc chest wall resection and appropriate reconstruction.In this proof-of-concept study, we aimed to produce personalized three-dimensional (3D)-printed chest wall prosthesis for a patient undergoing chest wall resection and reconstruction using clinically obtained computed tomography (CT) data. METHODS: Preoperative CT scans of three patients undergoing chest wall resection were analyzed and the areas of resection segmented. This was then used to produce a 3D print of the chest wall and a silicone mold was created from the model. This mold was sterilized and used to produce methyl methacrylate prostheses which were then implanted into the patients. RESULTS: Three patients had their chest wall reconstructed using this technique to produce a patient specific prosthesis. There were no early complications or deaths. CONCLUSIONS: It is possible to use 3D printing to produce a patient specific chest wall reconstruction for patients undergoing chest wall resection for malignancy that is cost-effective. This chest wall is thought to provide stability in the form of prosthetic ribs as well compliance in the form of an expanded polytetrafluoroethylene patch. Further research is required to measure chest wall compliance during the respiratory cycle and long-term follow-up from this method.