| The Surgical Technologist | JUNE 2022 262 trainees and a useful adjunct for communication with patients [161, 162]. Like every developing technology, it is still facing several limitations. For instance, the lack of elasticity of some materials precludes the use in certain cases where dissection planning is key. In terms of surgical planning, the high cost of 3DP equipment may limit the use of this technique in settings of limited financial resources; therefore, surgeons may choose to limit such techniques to complex or refractory cases. Future improvements in clinical applicability, in terms of raw materials to print with, speed of printing and reduced costs, are likely to make 3DP more widespread. 3.3.2. Hepatopancreatobiliary. The impact and influence of 3DP in hepatopancreatobiliary surgery have become a relevant and innovative tool for planning and performing complex surgeries, management of malignancies as well as surgical trainee, and patient education [16, 164–168]. The high precision that these models give to the surgeon is useful for the spatial orientation of relevant anatomic structures including portal vessels and hepatic veins, liver segments, biliary system, and pancreatic tumor location thereby enhancing surgical approach [168, 169]. In hepatobiliary surgery, the main application of 3DP is surgical planning, which is approximately 47% [170]. Nevertheless, the usefulness of this technology is not only based on this purpose, in fact, it showed an important value with intraoperative navigation during the surgery, from 80% of success for stent placement and wire manipulation to 100% for needle puncture [19, 171]. Indeed, studying the anatomic structures previous to the surgery and knowing the patientspecific anatomy clearly enhance the procedure [165, 170, 172]. The most common surgery for which 3D models were used is the resection of hepatic malignant neoplasms; however, its value in liver transplantation was also outstanding, especially for the use of landmarks and surgical procedure [169, 170, 173]. In spite of the fact that the surgical outcomes were not different among different studies, and most of the studies reported optimal results from the surgical planning point of view (Figure 6) [170]. Randomized controlled trials are necessary for assessing the outcomes. In biliary surgery, 3D models were mainly used for training purposes of choledochoscopy and ampullectomy, as well as the development of biliary stents [167, 174–176]. However, recently, some studies have shown the inclusion in other biliary pathologies. Zeng et al. reported a great stereoscopic sense in diagnosis and treatment of hilar cholangiocarcinoma; moreover, 3DP models improved the precision of the procedures and better patient outcomes [177]. In addition, Allan et al. found that these models were significantly useful in the treatment of congenital biliary cysts with Virtual endoscopy i i ii ii iii iii iv iv in cm 15 10 1 (a) 2cm 18.75 cm (b) Figure 5: (a) Visualization of 3D depth maps models of the esophagus. Techniques to determine the localization, length, and depth of the Barret’s lesions through the endoscopy camera. (b) 3D printed model of the esophagus that shows the measurements for the lesions (C and M) and also the endoscopy video frames are shown [163]. Used with permission from Elsevier. 10 BioMed Research International
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