title: Development and initial porcine and cadaver experience with three-dimensional printing of endoscopic and laparoscopic equipment.
abstract: BACKGROUND
  Recent advances in three-dimensional (3D) printing technology have made it possible to print surgical devices. We report our initial experience with the printing and deployment of endoscopic and laparoscopic equipment.
  
  
  METHODS
  We created computer-aided designs for ureteral stents and laparoscopic trocars using SolidWorks. We developed three generations of stents, which were printed with an Objet500 Connex printer, and a fourth generation was printed with an EOSINT P395 printer. The trocars were printed with an Objet30 Pro printer. We deployed the printed stents and trocars in a female cadaver and in vivo porcine model. We compared the printed trocars to two standard trocars for defect area and length using a digital caliper. Paired T-tests and ANOVA were used to test for statistical difference.
  
  
  RESULTS
  The first two generations of stents (7F and 9F) were functional failures as their diminutive inner lumen failed to allow the passage of a 0.035 guidewire. The third generation 12F stent allowed passage of a 0.035 guidewire. The 12F diameter limited its deployment, but it was introduced in a cadaver through a ureteral access sheath. The fourth-generation 9F stents were printed and deployed in a porcine model using the standard Seldinger technique. The printed trocars were functional for the maintenance of the pneumoperitoneum and instrument passage. The printed trocars had larger superficial defect areas (p<0.001) and lengths (p=0.001) compared to Karl Storz and Ethicon trocars (29.41, 18.06, and 17.22 mm(2), respectively, and 14.29, 11.39, and 12.15 mm, respectively).
  
  
  CONCLUSIONS
  In this pilot study, 3D printing of ureteral stents and trocars is feasible, and these devices can be deployed in the porcine and cadaver models. Three-dimensional printing is rapidly advancing and may be clinically viable in the future.
authors: Department of Urology, University of California , Irvine, Orange, California.
authors: Michael
authors: M
authors: del Junco
authors: Zhamshid
authors: Z
authors: Okhunov
authors: Renai
authors: R
authors: Yoon
authors: Ramtin
authors: R
authors: Khanipour
authors: Samuel
authors: S
authors: Juncal
authors: Garen
authors: G
authors: Abedi
authors: Achim
authors: A
authors: Lusch
authors: Jaime
authors: J
authors: Landman
mesh_terms: D000818:Animals; D002102:Cadaver; D017076:Computer-Aided Design; D004724:Endoscopy / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation; D010865:Pilot Projects; D066330:Printing, Three-Dimensional; D015607:Stents; D013525:Surgical Instruments; D013552:Swine; D014513:Ureter / Q000601:surgery*