A Systematic Review of the Clinical Value and Applications of Three-Dimensional Printing in Renal Surgery

Abstract

The purpose of this systematic review is to collate and analyse the current literature which examines clinical applications of 3D printing for renal disease, alongside cost and time duration factors associated with the printing process. A comprehensive search of the literature was performed across five different databases to identify studies that qualitatively and quantitatively assessed the value of 3D-printed kidney models for renal disease. Twenty-seven studies met the selection criteria for inclusion in the review. Twenty-five were original studies, and two were case reports. Of the 22 studies reporting a qualitative evaluation, the analysis of findings demonstrated the value of the 3D-printed models in areas of clinician and patient education, and pre-surgical simulation for complex cases of renal disease. Of five studies performing a quantitative analysis, the analysis of results displayed a high level of spatial and anatomical accuracy amongst models, with benefits including reducing estimated blood loss and risk of intra-operative complications. Fourteen studies evaluated manufacturing costs and time duration, with costs ranging from USD 1 to 1000 per model, and time duration ranging from 15 min to 9 days. This review shows that the use of customised 3D-printed models is valuable in the education of junior surgeons as well as the enhancement of operative skills for senior surgeons due to a superior visualisation of anatomical networks and pathologic morphology compared to volumetric imaging alone. Furthermore, 3D-printed kidney models may facilitate interdisciplinary communication and decision-making regarding the management of patients undergoing operative treatment for renal disease. It cannot be suggested that a more expensive material constitutes a higher level of user-satisfaction and model accuracy. However, higher costs in the manufacturing of the 3D-printed models reported, on average, a slightly shorter time duration for the 3D-printing process and total manufacturing time.

Keywords: model; renal cell carcinoma; renal disease; renal tumour; simulation; surgical planning; three-dimensional printing.

Figure 1

Flow chart demonstrating identification of relevant literature.

Figure 2

Different 3D-printer models/brands utilised based on the analysis of 27 studies.

Figure 3

Comparison of different 3D-printing technologies utilised according to the review of these studies.

Figure 4

3D-printed model of a 67-year-old male with renal tumour at the upper pole of left kidney. Comparative views of the CT scan at the nephrographic phase ((a) axial, (b) coronal, and (c) sagittal planes) and corresponding views of the physical model ((d) superior and median view, (e) median and anterior view, and (f) lateral view). An inferior polar cyst is also displayed on this model (translucent yellow). The cubes show the 3D-printed model orientation in space (I = inferior face, A = anterior face, L = lateral side, S = superior face, P = posterior face, M = median side). The patient underwent a left radical nephrectomy for a 65 × 56 × 42 mm clear cell renal cell carcinoma, pT1bN0Mx, Fuhrman grade 3. The arterial tree is presented in opaque magenta, the collecting system in opaque yellow, and opaque orange for tumour display. The renal vein and renal parenchyma are kept translucent to allow the best visualisation of the relationships between the renal tumour and surrounding structures. Reprinted with permission from Bernhard et al. [6].

Figure 5

3D-printed model of a 53-year-old female with a renal tumour at the interpolar region of left kidney. Comparative views of the CT scan at the nephrographic phase ((a) axial, (b) coronal, and (c) sagittal planes) and corresponding views of the physical model ((d) superior view, (e) median view, and (f) median view). The cubes show the 3D-printed model orientation in space (I = inferior face, A = anterior face, L = lateral side, S = superior face, P = posterior face, M = median side). The patient underwent a left partial nephrectomy for a 21 × 15 × 15 mm angiomyolipoma. Description of colour corresponding to different renal structures and tumour is the same as in Figure 4. Reprinted with permission from Bernhard et al. [6].