Usefulness of three-dimensional printing of superior mesenteric vessels in right hemicolon cancer surgery

Abstract

The anatomy of the superior mesenteric vessels is complex, yet important, for right-sided colorectal surgery. The usefulness of three-dimensional (3D) printing of these vessels in right hemicolon cancer surgery has rarely been reported. In this prospective clinical study, 61 patients who received laparoscopic surgery for right hemicolon cancer were preoperatively randomized into 3 groups: 3D-printing (20 patients), 3D-image (19 patients), and control (22 patients) groups. Surgery duration, bleeding volume, and number of lymph node dissections were designed to be the primary end points, whereas postoperative complications, post-operative flatus recovery time, duration of hospitalization, patient satisfaction, and medical expenses were designed to be secondary end points. To reduce the influence of including different surgeons in the study, the surgical team was divided into 2 groups based on surgical experience. The duration of surgery for the 3D-printing and 3D-image groups was significantly reduced (138.4 ± 19.5 and 154.7 ± 25.9 min vs. 177.6 ± 24.4 min, P = 0.000 and P = 0.006), while the number of lymph node dissections for the these 2 groups was significantly increased (19.1 ± 3.8 and 17.6 ± 3.9 vs. 15.8 ± 3.0, P = 0.001 and P = 0.024) compared to the control group. Meanwhile, the bleeding volume for the 3D-printing group was significantly reduced compared to the control group (75.8 ± 30.4 mL vs. 120.9 ± 39.1 mL, P = 0.000). Moreover, patients in the 3D-printing group reported increased satisfaction in terms of effective communication compared to those in the 3D-image and control groups. Medical expenses decreased by 6.74% after the use of 3D-printing technology. Our results show that 3D-printing technology could reduce the duration of surgery and total bleeding volume and increase the number of lymph node dissections. 3D-printing technology may be more helpful for novice surgeons.Trial registration: Chinese Clinical Trial Registry, ChiCTR1800017161. Registered on 15 July 2018.

Figure 1

3D-printed mesenteric vascular model placed next to the monitor for reference during surgery. (a) Before surgery, 3D printed mesenteric vessels were placed under the monitor, (b) During operation, 3D printing mesenteric vascular model can provide direct reference for surgeons.

Figure 2

The sample images of the control group (2D CT data), 3D-image group, and 3D-printing group for the same patient (a), and the printed mesenteric blood vessels (including detachable right halves and tumours) (b).

Figure 3

Surgical procedures for right hemicolon cancer: (a) trocar location, (b) opening of mesocolon above ileocolic vessels, (c) lymph node dissection at root of superior mesenteric vein (SMV) where the ileocolic vein (ICV) enters, (d) lymph node dissection at root of superior mesenteric artery (SMA) where the ileocolic artery (ICA) enters, (e) separation along right colic artery (RCA) and middle colic artery (MCA), (f) dissection of lymph nodes between left and right branches of MCA, (g) and (h) revealing anterior superior pancreaticoduodenal vein (ASPDV), right gastroepiploic vein (RGEV) and right colic artery (RCV), and dissected peripheral lymph nodes of Henle trunk (Henle T), and (i) excised right colon specimen.

Figure 4

Anatomy and variation of superior mesenteric vessels: (a) 3D-printed model showing anterior superior pancreaticoduodenal vein (ASPDV) and right gastroepiploic vein (RGEV) converging into Henle trunk; (b) discovery during surgery, which is similar to 3D-printed model shown in (a); (c) 3D-printed model showing right colic vein (RCV) converging into ASPDV and then forming Henle trunk with RGEV; (d) discovery during surgery, which is similar to 3D-printed model shown in (c); (e) 3D-printed model showing RCV, ASPDV, and RGEV converging together into Henle trunk; and (f) discovery during surgery, which is similar to 3D-printed model shown in (e).