title: Value of 3D printing for the comprehension of surgical anatomy.
abstract: In a preliminary experience, we claimed the potential value of 3D printing technology for pre-operative counseling and surgical planning. However, no objective analysis has ever assessed its additional benefit in transferring anatomical information from radiology to final users. We decided to validate the pre-operative use of 3D-printed anatomical models in patients with solid organs' diseases as a new tool to deliver morphological information.
  
  
  
  Fifteen patients scheduled for laparoscopic splenectomy, nephrectomy, or pancreatectomy were selected and, for each, a full-size 3D virtual anatomical object was reconstructed from a contrast-enhanced MDCT (Multiple Detector Computed Tomography) and then prototyped using a 3D printer. After having carefully evaluated-in a random sequence-conventional contrast MDCT scans, virtual 3D reconstructions on a flat monitor, and 3D-printed models of the same anatomy for each selected case, thirty subjects with different expertise in radiological imaging (10 medical students, 10 surgeons and 10 radiologists) were administered a multiple-item questionnaire. Crucial issues for the anatomical understanding and the pre-operative planning of the scheduled procedure were addressed.
  
  
  
  The visual and tactile inspection of 3D models allowed the best anatomical understanding, with faster and clearer comprehension of the surgical anatomy. As expected, less experienced medical students perceived the highest benefit (53.9% ± 4.14 of correct answers with 3D-printed models, compared to 53.4 % ± 4.6 with virtual models and 45.5% ± 4.6 with MDCT), followed by surgeons and radiologists. The average time spent by participants in 3D model assessing was shorter (60.67 ± 25.5 s) than the one of the corresponding virtual 3D reconstruction (70.8 ± 28.18 s) or conventional MDCT scan (127.04 ± 35.91 s).
  
  
  
  3D-printed models help to transfer complex anatomical information to clinicians, resulting useful in the pre-operative planning, for intra-operative navigation and for surgical training purposes.
authors.affiliation: Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Marconi
authors.affiliation: Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy. luipugliese@gmail.com.|Unit of General Surgery 2, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Piazzale Golgi, 19, 27100, Pavia, Italy. luipugliese@gmail.com.
authors.forename: Luigi
authors.identifier: 0000-0002-0537-4787
authors.initials: L
authors.lastname: Pugliese
authors.affiliation: School of Medicine, University of Pavia, Pavia, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Botti
authors.affiliation: Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Peri
authors.affiliation: Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Emma
authors.initials: E
authors.lastname: Cavazzi
authors.affiliation: General Surgery Unit, Ospedale Cannizzaro, Catania, Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Latteri
authors.affiliation: Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Auricchio
authors.affiliation: Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pietrabissa
mesh_terms: D032882:Comprehension; D058733:Hand-Assisted Laparoscopy / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy / Q000379:methods; D008953:Models, Anatomic; D061330:Multidetector Computed Tomography; D009392:Nephrectomy / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods*; D057234:Preoperative Period; D066330:Printing, Three-Dimensional; D013156:Splenectomy / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: 3D; Anatomy; Model; Printing; Surgery