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International Journal of Urology (2015)
doi: 10.1111/iju.12722
Letter to the Editor
Three-dimensional printing in urological surgery: What are the possibilities? We wish to bring to the attention of the readership the novel applications of 3-D printing technology in the field of urology. The concept of laying down material in successive cross-sectional layers for rapid prototyping has been described in the literature since 1984. However, recent improvements in ancillary technologies, such as 3-D image capture, as well as improved cost profiles have led to widespread application of 3-D printing technology ranging from aeronautics to agriculture. Various surgical fields have already embraced the so-called “third industrial revolution.” In maxillofacial surgery, 3-D printing has been used to construct mandibular prostheses post-ameloblastoma resection, which has been successfully implanted with reduced operative time compared with iliac bone grafting.1 3-D printing has also been used in orthopedic surgery to provide cheap and rapidly produced models for prefracture bone visualization. A mirror image of the unfractured acetabulum on computed tomography was used to print a hip joint that reproduces the bone configuration before fracture, allowing for plate sizing and moulding as well as screw trajectory planning.2 This technology has far-reaching implications for urological surgery. For example Del Junco et al. explored the possibility of printing ureteric stents and laparoscopic equipment. After several iterations, a 9-Fr ureteric stent was printed and deployed successfully in a porcine model. The printed trocar was able to successfully establish pneumoperitoneum and allow the passage of laparoscopic instruments.3 More recently, 3-D printing has been used to produce physical models of renal units with in situ lesions to assist with preoperative planning. Shiga et al. were able to print a kidney affected by a renal cell carcinoma to allow for robotic surgical planning.4 As the kidney was encased in a see-through resin, the authors reported being able to better visualize the vasculature path and tumor outline, allowing for greater precision and safety in resection. This development has the potential to overcome one of the greatest challenges in modern simulation training. The capability of this technology to simulate complex anatomy and pathology will allow trainees to progress further along the learning curve of minimally invasive procedures and gain exposure to more challenging cases. In addition, Silberstein et al. reported that the models not only led to improved trainee comprehension, but more importantly, improved patient understanding of their condition and treatment options.5 We feel that with time, growing interest in 3-D printing technology will bring about an even greater number of applications in the urological sciences. Many avenues are still to be explored; for example, testicular implants can be feasibly printed to replicate the patient’s own testicle in size and shape allowing
© 2015 The Japanese Urological Association
for greater fidelity. Additionally, penile and labial prostheses can be designed and modified in consultation with patients to achieve greater postoperative satisfaction in transgender surgery. Furthermore, 3-D printed prostate modules for preoperative planning could allow for familiarization of individual patient anatomy, especially with regards to the locations and pathways of nerves. This could reduce the rates of incontinence and erectile dysfunction complications after radical prostatectomy. We read with excitement the innovative ways in which additive manufacturing is transforming various surgical specialties. We eagerly anticipate future developments and novel techniques that apply 3-D printing technology to urological surgery. We feel that 3-D printing will not be a passing phenomenon, but has the potential to transform almost every aspect of urological surgery. However, a great deal of further research including rigorous clinical trials will be necessary to explore the full impact of this novel technology in urological surgery. Angela W Yu M.B.B.S., Hamid Abboudi M.R.C.S., Erik K Mayer Ph.D., F.R.C.S. and Justin A Vale Ph.D., F.R.C.S. Department of Surgery and Cancer, Imperial College London, London, UK [email protected]
Conflict of interest None declared.
References 1 Cohen A, Laviv A, Berman P, Nashef R, Abu-Tair J. Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology. Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. Endod. 2009; 108: 661–6. 2 Duncan JM, Daurka J, Akhtar K. Use of 3D printing in orthopaedic surgery. BMJ 2014; 348: g2963–g2963. 3 Del Junco M, Okhunov Z, Yoon R et al. Development and Initial Porcine and Cadaver Experience with Three-Dimensional Printing of Endoscopic and Laparoscopic Equipment. J. Endourol. 2015; 29: 58–62. 4 Shiga Y, Sugimoto MS, Iwabuchi TI et al. Benefit of three-dimensional printing in robotic laparoscopic renal surgery: Tangible surgical navigation using a patient-based three-dimensional printed kidney [abstract]. In: Proceedings of the th th 29 Annual European Association of Urology Congress, 2014; 11-15 April; Stockholm, Sweden. Abstract 1124. 5 Silberstein JL, Maddox MM, Dorsey P, Feibus A, Thomas R, Lee BR. Physical models of renal malignancies using standard cross-sectional imaging and 3-dimensional printers: a pilot study. Urology 2014; 84: 26872.
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International Journal of Urology (2015)
doi: 10.1111/iju.12722
Letter to the Editor
Three-dimensional printing in urological surgery: What are the possibilities? We wish to bring to the attention of the readership the novel applications of 3-D printing technology in the field of urology. The concept of laying down material in successive cross-sectional layers for rapid prototyping has been described in the literature since 1984. However, recent improvements in ancillary technologies, such as 3-D image capture, as well as improved cost profiles have led to widespread application of 3-D printing technology ranging from aeronautics to agriculture. Various surgical fields have already embraced the so-called “third industrial revolution.” In maxillofacial surgery, 3-D printing has been used to construct mandibular prostheses post-ameloblastoma resection, which has been successfully implanted with reduced operative time compared with iliac bone grafting.1 3-D printing has also been used in orthopedic surgery to provide cheap and rapidly produced models for prefracture bone visualization. A mirror image of the unfractured acetabulum on computed tomography was used to print a hip joint that reproduces the bone configuration before fracture, allowing for plate sizing and moulding as well as screw trajectory planning.2 This technology has far-reaching implications for urological surgery. For example Del Junco et al. explored the possibility of printing ureteric stents and laparoscopic equipment. After several iterations, a 9-Fr ureteric stent was printed and deployed successfully in a porcine model. The printed trocar was able to successfully establish pneumoperitoneum and allow the passage of laparoscopic instruments.3 More recently, 3-D printing has been used to produce physical models of renal units with in situ lesions to assist with preoperative planning. Shiga et al. were able to print a kidney affected by a renal cell carcinoma to allow for robotic surgical planning.4 As the kidney was encased in a see-through resin, the authors reported being able to better visualize the vasculature path and tumor outline, allowing for greater precision and safety in resection. This development has the potential to overcome one of the greatest challenges in modern simulation training. The capability of this technology to simulate complex anatomy and pathology will allow trainees to progress further along the learning curve of minimally invasive procedures and gain exposure to more challenging cases. In addition, Silberstein et al. reported that the models not only led to improved trainee comprehension, but more importantly, improved patient understanding of their condition and treatment options.5 We feel that with time, growing interest in 3-D printing technology will bring about an even greater number of applications in the urological sciences. Many avenues are still to be explored; for example, testicular implants can be feasibly printed to replicate the patient’s own testicle in size and shape allowing
© 2015 The Japanese Urological Association
for greater fidelity. Additionally, penile and labial prostheses can be designed and modified in consultation with patients to achieve greater postoperative satisfaction in transgender surgery. Furthermore, 3-D printed prostate modules for preoperative planning could allow for familiarization of individual patient anatomy, especially with regards to the locations and pathways of nerves. This could reduce the rates of incontinence and erectile dysfunction complications after radical prostatectomy. We read with excitement the innovative ways in which additive manufacturing is transforming various surgical specialties. We eagerly anticipate future developments and novel techniques that apply 3-D printing technology to urological surgery. We feel that 3-D printing will not be a passing phenomenon, but has the potential to transform almost every aspect of urological surgery. However, a great deal of further research including rigorous clinical trials will be necessary to explore the full impact of this novel technology in urological surgery. Angela W Yu M.B.B.S., Hamid Abboudi M.R.C.S., Erik K Mayer Ph.D., F.R.C.S. and Justin A Vale Ph.D., F.R.C.S. Department of Surgery and Cancer, Imperial College London, London, UK [email protected]
Conflict of interest None declared.
References 1 Cohen A, Laviv A, Berman P, Nashef R, Abu-Tair J. Mandibular reconstruction using stereolithographic 3-dimensional printing modeling technology. Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. Endod. 2009; 108: 661–6. 2 Duncan JM, Daurka J, Akhtar K. Use of 3D printing in orthopaedic surgery. BMJ 2014; 348: g2963–g2963. 3 Del Junco M, Okhunov Z, Yoon R et al. Development and Initial Porcine and Cadaver Experience with Three-Dimensional Printing of Endoscopic and Laparoscopic Equipment. J. Endourol. 2015; 29: 58–62. 4 Shiga Y, Sugimoto MS, Iwabuchi TI et al. Benefit of three-dimensional printing in robotic laparoscopic renal surgery: Tangible surgical navigation using a patient-based three-dimensional printed kidney [abstract]. In: Proceedings of the th th 29 Annual European Association of Urology Congress, 2014; 11-15 April; Stockholm, Sweden. Abstract 1124. 5 Silberstein JL, Maddox MM, Dorsey P, Feibus A, Thomas R, Lee BR. Physical models of renal malignancies using standard cross-sectional imaging and 3-dimensional printers: a pilot study. Urology 2014; 84: 26872.
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