scholarly journals Use of a 3D-Printed Patient-Specific Surgical Jig and Ready-Made Total Sacral Endoprosthesis for Total Sacrectomy and Reconstruction

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Qianyu Shi ◽  
Tao Ji ◽  
Siyi Huang ◽  
Xiaodong Tang ◽  
Rongli Yang ◽  
...  
Keyword(s):  
Surgical Margin ◽  
Operation Time ◽  
Patient Specific ◽  
En Bloc ◽  
Sacral Tumor ◽  
3D Printed ◽  
The Mean ◽  
Sacral Tumors ◽  
Single Posterior Approach ◽  
Total Sacrectomy

Objective. In the present study, the authors aimed to optimize the workflow of utilizing a 3D printing technique during surgical treatment for malignant sacral tumors, mainly on preparation of patient-specific surgical jigs and ready-made 3D-printed total sacral endoprosthesis. Methods. Three patients with a malignant sacral tumor received total sacrectomy with preoperative design of a patient-specific 3D-printed cutting jig and endoprosthetic reconstruction. Size of ready-made 3D-printed endoprosthesis was determined based on preoperative images, planned surgical margin, and size of the endoprosthesis. A patient-specific cutting jig was designed with a bilateral cutting slot matching the bilateral planes of the implant precisely. The tumor was removed en bloc through a single posterior approach only, being followed by reconstruction with ready-made total sacral endoprosthesis. Results. The mean time for preoperative design and manufacture of the surgical jig was 6.3 days. Surgical jigs were successfully used during surgery and facilitated the osteotomy. The mean operation time was 177 minutes (range 150-190 minutes). The mean blood loss was 3733 ml (range 3600-4000 ml). R0 resections were achieved in all the three cases proven by pathology. Evaluation of osteotomy accuracy was conducted by comparing preoperative plans and postoperative CT scans. The mean osteotomy deviation was 2.1 mm (range 0-4 mm), and mean angle deviation of osteotomy was 3.2° (range 0-10°). At a mean follow-up of 18.7 months, no local recurrence was observed. One patient had lung metastasis 15 months after surgery. Two patients were alive with no evidence of the disease. Conclusions. The patient-specific surgical jig and ready-made 3D-printed total sacral endoprosthesis can shorten the surgical preparation time preoperatively, facilitating accurate osteotomy and efficient reconstruction intraoperatively. The workflow seems to be feasible and practical.

scholarly journals Quality Control in 3D Printing: Accuracy Analysis of 3D-Printed Models of Patient-Specific Anatomy

Materials ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 1021
Author(s):  
Bernhard Dorweiler ◽  
Pia Elisabeth Baqué ◽  
Rayan Chaban ◽  
Ahmed Ghazy ◽  
Oroa Salem
Keyword(s):  
Wall Thickness ◽  
Large Scale ◽  
Fused Deposition Modeling ◽  
Vascular Anatomy ◽  
3D Models ◽  
Patient Specific ◽  
Stl File ◽  
Fused Deposition ◽  
3D Printed ◽  
The Mean

As comparative data on the precision of 3D-printed anatomical models are sparse, the aim of this study was to evaluate the accuracy of 3D-printed models of vascular anatomy generated by two commonly used printing technologies. Thirty-five 3D models of large (aortic, wall thickness of 2 mm, n = 30) and small (coronary, wall thickness of 1.25 mm, n = 5) vessels printed with fused deposition modeling (FDM) (rigid, n = 20) and PolyJet (flexible, n = 15) technology were subjected to high-resolution CT scans. From the resulting DICOM (Digital Imaging and Communications in Medicine) dataset, an STL file was generated and wall thickness as well as surface congruency were compared with the original STL file using dedicated 3D engineering software. The mean wall thickness for the large-scale aortic models was 2.11 µm (+5%), and 1.26 µm (+0.8%) for the coronary models, resulting in an overall mean wall thickness of +5% for all 35 3D models when compared to the original STL file. The mean surface deviation was found to be +120 µm for all models, with +100 µm for the aortic and +180 µm for the coronary 3D models, respectively. Both printing technologies were found to conform with the currently set standards of accuracy (<1 mm), demonstrating that accurate 3D models of large and small vessel anatomy can be generated by both FDM and PolyJet printing technology using rigid and flexible polymers.

scholarly journals The Use of Patient-Specific 3D Printed Titanium Implants for Complex Foot and Ankle Limb Salvage, Deformity Correction, and Arthrodesis Procedures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Samuel Adams ◽  
Travis Dekker ◽  
John Steele ◽  
Kamran Hamid
Keyword(s):  
Lower Extremity ◽  
Deformity Correction ◽  
Titanium Implants ◽  
Patient Specific ◽  
Allograft Bone ◽  
Foot And Ankle ◽  
Sf 36 ◽  
3D Printed ◽  
The Mean

Category: Ankle,Ankle Arthritis,Basic Sciences/Biologics,Trauma Introduction/Purpose: Large lower extremity bony defects, complex foot and ankle deformities, and high-risk arthrodesis situations can be difficult to treat. These challenging pathologies, often require a critical-sizes and/or shaped structural bone void filler which may not be available with allograft bone. The advancement of 3D printing technology has allowed for the use of custom designed implants for foot and ankle surgery. This study reports on the radiographic and functional outcomes of a case series of patients treated with patient-specific 3D printed titanium implants. Methods: Seven consecutive patients who were treated with custom designed 3D printed implant cages for severe bone loss, deformity correction, and arthrodesis procedures were included in this study. A minimum of 1-year follow-up was required. No patients were lost to follow-up. Patients completed preoperative and most recent follow-up VAS for pain, FAAM, and SF-36 outcomes questionnaires. All patients had post-operative radiographs and CT scans to assess bony incorporation. Results: The mean age of these patients was 54.6 (35-73 years of age). The mean follow-up of these seven patients was 17.1 months (range 12 to 31). Radiographic fusion with cage ingrowth and integration occurred in all seven patients verified by CT scan. There was statistically significant improvement in all functional outcome score measures (VAS for pain, FAAM, and SF-36). All patients returned were satisfied with surgery. There were no failures. Case examples are demonstrated in Figure 1. Conclusion: This cohort of patients demonstrated the successful use of custom 3D printed implants to treat complex large bony defects, deformities and arthrodesis procedures of the lower extremity. These implants offer the surgeon a patient specific approach to treat both pain and deformity that is not necessarily available with allograft bone.

Application of Personalized Navigation Templates to Oxford Single Condylar Replacement in a Chinese Population

2020 ◽  
Author(s):  
Yudong Gan ◽  
Jian Zhuang ◽  
Wenxiao Jiang ◽  
Wei Sun ◽  
Yijun Zhang
Keyword(s):  
Conventional Method ◽  
Tibial Plateau ◽  
Operation Time ◽  
Flip Angle ◽  
Patient Specific ◽  
X Rays ◽  
Femoral Prosthesis ◽  
Valgus Angle ◽  
The Mean ◽  
Therapeutic Study

AbstractThe purpose of this study is to develop and validate a novel patient-specific navigational template for unicompartmental knee arthroplasty (UKA). A total of 120 patients who underwent UKA were randomized and divided into the conventional method and navigational template groups. In the navigational template group, patient-specific navigational templates were designed and used intraoperatively to assist 60 patients with UKA. Information on operation time and blood loss was recorded by an independent operating room nurse. After surgery, the positions of the prostheses were evaluated using X-rays. All navigation templates were found to fit its corresponding biomodel appropriately without any free movement. The navigational template exhibited significantly better accuracy than the conventional method. Statistically significant differences in the femoral prosthesis flip angle, femoral prosthesis flexion angle, and tibial plateau varus and valgus angle were observed between the two groups (p = 0.022, 0.042, 0.043, respectively). In addition, the mean operation time was statistically and significantly lower in the navigational template group than in the conventional group (p = 0.035). This study introduces a novel navigational template to UKA, the accuracy of which is proven by clinical operation. This is a Level III, therapeutic study.

Sacral tumor resection and the impact on pelvic incidence

2011 ◽  
Vol 14 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Oren N. Gottfried ◽  
Ibrahim Omeis ◽  
Vivek A. Mehta ◽  
Can Solakoglu ◽  
Ziya L. Gokaslan ◽  
...  
Keyword(s):  
Pelvic Incidence ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Clinical Importance ◽  
Johns Hopkins Hospital ◽  
En Bloc ◽  
Sacral Tumor ◽  
Si Joint ◽  
The Impact ◽  
Total Sacrectomy

Object Pelvic incidence (PI) directly regulates lumbar lordosis and is a key determinant of sagittal spinal balance in normal and diseased states. Pelvic incidence is defined as the angle between the line perpendicular to the S-1 endplate at its midpoint and the line connecting this point to a line bisecting the center of the femoral heads. It reflects an anatomical value that increases with growth during childhood but remains constant in adulthood. It is not altered by changes in patient position or after traditional lumbosacral spinal surgery. There are only 2 reports of PI being altered in adults, both in cases of sacral fractures resulting in lumbopelvic dissociation and sacroiliac (SI) joint instability. En bloc sacral amputation and sacrectomy are surgical techniques used for resection of certain bony malignancies of the sacrum. High, mid, and low sacral amputations result in preservation of some or the entire SI joint. Total sacrectomy results in complete disruption of the SI joint. The purpose of this study was to determine if PI is altered as a result of total or subtotal sacral resection. Methods The authors reviewed a series of 42 consecutive patients treated at The Johns Hopkins Hospital between 2004 and 2009 for sacral tumors with en bloc resection. The authors evaluated immediate pre- and postoperative images for modified pelvic incidence (mPI) using the L-5 inferior endplate, as the patients undergoing a total sacrectomy are missing the S-1 endplate postoperatively. The authors compared the results of total versus subtotal sacrectomies. Results Twenty-two patients had appropriate images to measure pre- and postoperative mPI; 17 patients had high, mid, or low sacral amputations with sparing of some or the entire SI joint, and 5 patients underwent a total sacrectomy, with complete SI disarticulation. The mean change in mPI was statistically different (p < 0.001) for patients undergoing subtotal versus those undergoing total sacrectomy (1.6° ± 0.9° vs 13.6° ± 4.9° [± SD]). There was no difference between patients who underwent a high sacral amputation (partial SI resection, mean 1.6°) and mid or low sacral amputation (SI completely intact, mean 1.6°). Conclusions The PI is altered during total sacrectomy due to complete disarticulation of the SI joint and discontinuity of the spine and pelvis, but it is not changed if any of the joint is preserved. Changes in PI influence spinopelvic balance and may have postoperative clinical importance. Thus, the authors encourage attention to spinopelvic alignment during lumbopelvic reconstruction and fixation after tumor resection. Long-term studies are needed to evaluate the impact of the change in PI on sagittal balance, pain, and ambulation after total sacrectomy.

scholarly journals Patient-Specific Quality Assurance Using a 3D-Printed Chest Phantom for Intraoperative Radiotherapy in Breast Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Yeonho Choi ◽  
Ik Jae Lee ◽  
Kwangwoo Park ◽  
Kyung Ran Park ◽  
Yeona Cho ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Soft Tissue ◽  
Three Dimensional ◽  
Intraoperative Radiotherapy ◽  
Hounsfield Unit ◽  
Patient Specific ◽  
Depth Dose ◽  
Dose Comparison ◽  
3D Printed ◽  
The Mean

This study aims to confirm the usefulness of patient-specific quality assurance (PSQA) using three-dimensional (3D)-printed phantoms in ensuring the stability of IORT and the precision of the treatment administered. In this study, five patient-specific chest phantoms were fabricated using a 3D printer such that they were dosimetrically equivalent to the chests of actual patients in terms of organ density and shape around the given target, where a spherical applicator was inserted for breast IORT treatment via the INTRABEAM™ system. Models of lungs and soft tissue were fabricated by applying infill ratios corresponding to the mean Hounsfield unit (HU) values calculated from CT scans of the patients. The two models were then assembled into one. A 3D-printed water-equivalent phantom was also fabricated to verify the vendor-provided depth dose curve. Pieces of an EBT3 film were inserted into the 3D-printed customized phantoms to measure the doses. A 10 Gy prescription dose based on the surface of the spherical applicator was delivered and measured through EBT3 films parallel and perpendicular to the axis of the beam. The shapes of the phantoms, CT values, and absorbed doses were compared between the expected and printed ones. The morphological agreement among the five patient-specific 3D chest phantoms was assessed. The mean differences in terms of HU between the patients and the phantoms was 2.2 HU for soft tissue and −26.2 HU for the lungs. The dose irradiated on the surface of the spherical applicator yielded a percent error of −2.16% ± 3.91% between the measured and prescribed doses. In a depth dose comparison using a 3D-printed water phantom, the uncertainty in the measurements based on the EBT3 film decreased as the depth increased beyond 5 mm, and a good agreement in terms of the absolute dose was noted between the EBT3 film and the vendor data. These results demonstrate the applicability of the 3D-printed chest phantom for PSQA in breast IORT. This enhanced precision offers new opportunities for advancements in IORT.

scholarly journals Feasibility of Endoscopy-Assisted Laparoscopic Full-Thickness Resection for Superficial Duodenal Neoplasms

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Ken Ohata ◽  
Masahiko Murakami ◽  
Kimiyasu Yamazaki ◽  
Kouichi Nonaka ◽  
Nobutsugu Misumi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Operation Time ◽  
Full Thickness ◽  
Duodenal Neoplasms ◽  
Invasive Treatment ◽  
En Bloc ◽  
Estimated Blood Loss ◽  
Delayed Perforation ◽  
The Mean

Background. Superficial duodenal neoplasms (SDNs) are a challenging target in the digestive tract. Surgical resection is invasive, and it is difficult to determine the site and extent of the lesion from outside the intestine and resect it locally. Endoscopic submucosal dissection (ESD) has scarcely been utilized in the treatment of duodenal tumors because of technical difficulties and possible delayed perforation due to the action of digestive juices. Thus, no standard treatments for SDNs have been established. To challenge this issue, we elaborated endoscopy-assisted laparoscopic full-thickness resection (EALFTR) and analyzed its feasibility and safety.Methods. Twenty-four SDNs in 22 consecutive patients treated by EALFTR between January 2011 and July 2012 were analyzed retrospectively.Results. All lesions were removed en bloc. The lateral and vertical margins of the specimens were negative for tumor cells in all cases. The mean sizes of the resected specimens and lesions were 28.9 mm (SD ± 10.5) and 13.3 mm (SD ± 11.6), respectively. The mean operation time and intraoperative estimated blood loss were 133 min (SD ± 45.2) and 16 ml (SD ± 21.1), respectively. Anastomotic leakage occurred in three patients (13.6%) postoperatively, but all were minor leakage and recovered conservatively. Anastomotic stenosis or bleeding did not occur.Conclusions. EALFTR can be a safe and minimally invasive treatment option for SDNs. However, the number of cases in this study was small, and further accumulations of cases and investigation are necessary.

Accuracy of 3D printed guide for orbital implant

2020 ◽  
Vol 26 (8) ◽  
pp. 1363-1370
Author(s):  
Jaeyoung Kwon ◽  
Guk Bae Kim ◽  
Sunah Kang ◽  
Younghwa Byeon ◽  
Ho-Seok Sa ◽  
...  
Keyword(s):  
3D Printing ◽  
Patient Specific ◽  
Orbital Fracture ◽  
Uv Curable ◽  
Content Type ◽  
Orbital Implant ◽  
Surgical Guides ◽  
3D Printed ◽  
The Mean ◽  
Mean Differences

Purpose Extrinsic trauma to the orbit may cause a blowout or orbital fracture, which often requires surgery for reconstruction of the orbit and repositioning of the eyeball with an implant. Post-operative complications, however, are high with the most frequent cause of complications being a mismatch of the position and shape of the implant and fracture. These mismatches may be reduced by computed tomography (CT) based modeling and three-dimensional (3D) printed guide. Therefore, the aim of this study is to propose and evaluate a patient-specific guide to shape an orbital implant using 3D printing. Design/methodology/approach Using CT images of a patient, an orbital fracture can be modeled to design an implant guide for positioning and shaping of the surface and boundaries of the implant. The guide was manufactured using UV curable plastic at 0.032 mm resolution by a 3D printer. The accuracy of this method was evaluated by micro-CT scanning of the surgical guides and shaping implants. Findings The length and depth of the 3D model, press-compressed and decompressed implants were compared. The mean differences in length were 0.67 ± 0.38 mm, 0.63 ± 0.28 mm and 0.10 ± 0.10 mm, and the mean differences in depth were 0.64 ± 0.37 mm, 1.22 ± 0.56 mm and 0.57 ± 0.23 mm, respectively. Statistical evaluation was performed with a Bland-Altman plot. Originality/value This study suggests a patient-specific guide to shape an orbital implant using 3D printing and evaluate the guiding accuracy of the implant versus the planned model.

Midsacral Amputation for En Bloc Resection of Chordoma

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-41-ons-44 ◽  
Author(s):  
Ganesh Rao ◽  
George J. Chang ◽  
Ian Suk ◽  
Ziya Gokaslan ◽  
Laurence D. Rhines
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Margins ◽  
En Bloc ◽  
Sacral Chordoma ◽  
Sacral Tumor ◽  
Tumors Of The Sacrum ◽  
Successful Removal ◽  
Sacral Tumors

Abstract Background: En bloc resection, with adequate surgical margins, of primary malignant bone tumors of the sacrum is associated with long term disease control and potential cure. Resection of sacral tumors is difficult due to the proximity of neurovascular and visceral structures, and complete, or even partial, sacrectomy often results in functional loss for the patient. Objective: We describe the technique for en bloc resection of a sacral chordoma through a mid-sacral amputation. Results: We demonstrate successful removal of a large sacral tumor with wide surgical margins while preserving neurologic function. Conclusion: This technique for midsacral amputation to remove a sacral tumor en bloc minimizes local recurrence and maximizes neurovascular function.

scholarly journals Endoscopic Submucosal Tunnel Dissection for Large Gastric Neoplastic Lesions: A Case-Matched Controlled Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Xiuxue Feng ◽  
Enqiang Linghu ◽  
Ningli Chai ◽  
Zhongsheng Lu ◽  
Xiangdong Wang ◽  
...  
Keyword(s):  
Operation Time ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Gastric Body ◽  
Controlled Study ◽  
Resected Specimen ◽  
En Bloc ◽  
Submucosal Tunnel ◽  
Endoscopic Submucosal Tunnel Dissection ◽  
The Mean

Aim. To evaluate the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) for resection of large superficial gastric lesions (SGLs). Methods. The clinicopathological records of patients performed with ESTD or endoscopic submucosal dissection (ESD) for SGLs between January 2012 and January 2014 were retrospectively reviewed. 7 cases undergoing ESTD were enrolled to form the ESTD group. The cases were individually matched at a 1 : 1 ratio to other patients performed with ESD according to lesion location, ulcer or scar findings, resected specimen area, operation time and operators, and the matched cases constituting the ESD group. The treatment outcomes were compared between the two groups. Results. The mean specimen size was 46 mm. 10 lesions were located in the cardia and 4 lesions in the lesser curvature of the lower gastric body. En bloc resection was achieved for all lesions. The mean ESTD resection time was 69 minutes as against 87.7 minutes for the ESD (P=0.01). The mean resection speed was faster for ESTD than for ESD (18.86 mm2/min versus 13.76 mm2/min, P=0.03). There were no significant differences regarding the safety and curability during the endoscopic follow-up (mean 27 months). Conclusions. ESTD is effective and safe for the removal of SGLs and appears to be an optimal option for patients with large SGLs at suitable sites.

Reconstruction of the pelvic ring after total en bloc sacrectomy using a 3D-printed sacral endoprosthesis with re-establishment of spinopelvic stability

2019 ◽  
Vol 101-B (7) ◽  
pp. 880-888 ◽  
Author(s):  
R. Wei ◽  
W. Guo ◽  
R. Yang ◽  
X. Tang ◽  
Y. Yang ◽  
...  
Keyword(s):  
Pelvic Ring ◽  
Perioperative Complications ◽  
Spinal Column ◽  
En Bloc ◽  
Bone Implant ◽  
Spinopelvic Fixation ◽  
3D Printed ◽  
Perioperative Complication ◽  
The Mean

Aims The aim of this study was to describe the use of 3D-printed sacral endoprostheses to reconstruct the pelvic ring and re-establish spinopelvic stability after total en bloc sacrectomy (TES) and to review its outcome. Patients and Methods We retrospectively reviewed 32 patients who underwent TES in our hospital between January 2015 and December 2017. We divided the patients into three groups on the basis of the method of reconstruction: an endoprosthesis group (n = 10); a combined reconstruction group (n = 14), who underwent non-endoprosthetic combined reconstruction, including anterior spinal column fixation; and a spinopelvic fixation (SPF) group (n = 8), who underwent only SPF. Spinopelvic stability, implant survival (IS), intraoperative haemorrhage rate, and perioperative complication rate in the endoprosthesis group were documented and compared with those of other two groups. Results The mean overall follow-up was 22.1 months (9 to 44). In the endoprosthesis group, the mean intraoperative hemorrhage was 3530 ml (1600 to 8100). Perioperative complications occurred in two patients; both had problems with wound healing. After a mean follow-up of 17.7 months (12 to 38), 9/10 patients could walk without aids and 8/10 patients were not using analgesics. Imaging evidence of implant failure was found in three patients, all of whom had breakage of screws and/or rods. Only one of these, who had a local recurrence, underwent re-operation, at which solid bone-endoprosthetic osseointegration was found. The mean IS using re-operation as the endpoint was 32.5 months (95% confidence interval 23.2 to 41.8). Compared with the other two groups, the endoprosthesis group had significantly better spinopelvic stability and IS with no greater intraoperative haemorrhage or perioperative complications. Conclusion The use of 3D-printed endoprostheses for reconstruction after TES provides reliable spinopelvic stability and IS by facilitating osseointegration at the bone-implant interfaces, with acceptable levels of haemorrhage and complications. Cite this article: Bone Joint J 2019;101-B:880–888.

Sign in / Sign up

Export Citation Format

Share Document