Presented by: Ryan Buettner MD
Southern Illinois University School of Medicine

Introduction

Preoperative planning for complex surgical procedures can be important for successful outcomes. Anatomical relationships on two-dimensional radiographs such as computed tomography and magnetic resonance imaging do not always clarify or define these relationships. The use of 3-dimensional printing has gained interest recently in preoperative planning and can afford a better look at anatomical relationships prior to entering the operative environment.

Materials

We employed 3-D printing to help plan two robotic pelvic neurofibroma excisions and 5 robotic partial nephrectomies for complex renal tumors. Models printed on the Makerbot were brought into the Makerbot Print software as .stl files, arranged, sliced and exported to a usb drive.  The print file was then transferred to the Makerbot printer via the usb. All prints have included a raft at the base and supports as needed. Supports are breakaway structures printed to provide a base while printing overhanging parts.  The PLA supports are removed by hand, and with tools such as needle nose pliers. Given only the single nozzle, the supports are the same PLA used to create the model. After the model was printed in white PLA and, after supports were removed, they were then painted with acrylic paints.

Results

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All operations were successful in renal preservation and excision of the neurofibromas. Pathology was showed negative margins in all patients and the neurofibroma patients have had resolution of their presenting lower extremity pain. We found the most important factor in utilizing 3D printing was the relationship between disease and vital structures.

Conclusion

Preoperative 3-D printing of complex disease states may help in deciphering difficult or complex anatomy. As technology improves and costs of printing and printers decrease, utilization of this technology may become commonplace in operative planning.

Funding

None

Lead Authors

Ron Hidalgo, MD
Memorial Medical Center

Brad Schwartz, DO
Southern Illinois University School of Medicine