title: Individualizing Management of Complex Esophageal Pathology Using Three-Dimensional Printed Models.
abstract: OBJECTIVE
  In complex esophageal cases, conventional two-dimensional imaging is limited in demonstrating anatomic relationships. We describe the utility of three-dimensional (3D) printed models for complex patients to individualize care.
  
  
  METHODS
  Oral effervescent agents, with positive enteric contrast, distended the esophagus during computed tomography (CT) scanning to facilitate segmentation during post-processing. The CT data were segmented, converted into a stereolithography file, and printed using photopolymer materials.
  
  
  RESULTS
  In 1 patient with a left pneumonectomy, aortic bypass, and esophageal diversion, 3D printing enabled visualization of the native esophagus and facilitated endoscopic mucosal resection, followed by hiatal dissection and division of the gastroesophageal junction as treatment. In a second patient, 3D printing allowed enhanced visualization of multiple esophageal diverticula, allowing for optimization of the surgical approach.
  
  
  CONCLUSIONS
  Printing of 3D anatomic models in patients with complex esophageal pathology facilitates planning the optimal surgical approach and anticipating potential difficulties for the multidisciplinary team. These models are invaluable for patient education.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Dickinson
authors.affiliation: Division of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jane
authors.initials: J
authors.lastname: Matsumoto
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Reinersman
authors.affiliation: Division of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joel G
authors.initials: JG
authors.lastname: Fletcher
authors.affiliation: Division of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Morris
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Wong Kee Song
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: blackmon.shanda@mayo.edu.
authors.forename: Shanda H
authors.initials: SH
authors.lastname: Blackmon
mesh_terms: D000328:Adult; D000368:Aged; D004935:Esophageal Diseases / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008953:Models, Anatomic; D057285:Precision Medicine / Q000379:methods*; D066330:Printing, Three-Dimensional