Elsevier

Journal of Pediatric Surgery

Volume 50, Issue 12, December 2015, Pages 2112-2115
Journal of Pediatric Surgery

PAPS Paper
Preoperative surgical simulation of laparoscopic adrenalectomy for neuroblastoma using a three-dimensional printed model based on preoperative CT images

https://doi.org/10.1016/j.jpedsurg.2015.08.037Get rights and content

Abstract

Background

Three-dimensional (3D) printed models based on computed tomography (CT) images facilitate the visualization of complex structures and are useful for understanding the surgical anatomy preoperatively. We developed a preoperative surgical simulation method using a 3D printed model based on CT images obtained prior to laparoscopic adrenalectomy for adrenal neuroblastomas (NBs).

Materials and methods

The multi-detector CT images were transferred to a 3D workstation, and 3D volume data were obtained by reconstructing the sections. A model was made with a 3D printer using acrylic ultraviolet curable resin. The adrenal tumor, kidney, renal vein and artery, inferior vena cava, aorta, and outer body were fabricated. The pneumoperitoneum, insertion of trocars, and laparoscopic view were all attainable in this model. We used this model for three cases with adrenal NB.

Results

We used this model to discuss the port layout before the operation and to simulate the laparoscopic view and range of forceps movement. All three cases with NB were completely resected without any surgical complications.

Conclusions

The surgical simulation using 3D printed models based on preoperative CT images for adrenal NB was very useful for understanding the patient’s surgical anatomy and for planning the surgical procedures, especially for determining the optimal port layout.

Section snippets

Materials and methods

Scanning was performed using a multi-detector CT scanner with 64 detectors. Iopamidol was administered intravenously as contrast medium. The setting for collimation was 3 mm. The multi-detector CT images were transferred to a 3D workstation (ZedView, 3D Doctor, FreeForm, an analytical software program, and CATIA, a three-dimensional interactive application program) and the 3D volume data for the target organs were obtained by reconstructing the sections. A model was printed on an Objet 500

Results

The 3D printed model was used for three neuroblastoma patients. The clinical data for the patients treated with the surgical simulation using the 3D printed model are shown in Table 1. The age of the patients at the time of the operation ranged from 1 month to 20 months, the body weight ranged from 4.1 kg to 10.4 kg, and the tumor size ranged from 2.5 to 6.0 cm. Two cases had stage 4 NB and one case had a stage 1 NB. None of the cases showed MYCN amplification. Two of the three patients underwent

Discussion

We fabricated a 3D printed model for adrenal NBs and performed a surgical simulation using the 3D printed model for three cases of NB. This is the first report of a 3D printed model for laparoscopic surgical simulation in children. This model allowed the insertion of trocars and optimization of the trocar layout. This model also made it easier to understand the patient’s anatomy and to simulate the laparoscopic view and range of forceps movement for laparoscopic adrenalectomy preoperatively.

Acknowledgments

The English used in this manuscript was reviewed by Brian Quinn (Editor-in-Chief, Japan Medical Communication). This work was supported by KAKENHI Grant-in-Aid for Scientific Research (C) (15K10924).

References (18)

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