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Journal ArticleDOI

Three‐dimensional print of a liver for preoperative planning in living donor liver transplantation

TL;DR: A protocol is developed and successfully 3D‐printed synthetic livers (along with their complex networks of vascular and biliary structures) replicating the native livers of 6 patients: 3 living donors and 3 respective recipients who underwent LDLT, to be the first complete 3D-printed livers.
About: This article is published in Liver Transplantation.The article was published on 2013-12-01 and is currently open access. It has received 248 citations till now. The article focuses on the topics: Liver transplantation & Hepatectomy.
Citations
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Journal ArticleDOI
TL;DR: This review outlines recent progress in several bioprinting technologies used to engineer scaffolds with requisite mechanical, structural, and biological complexity and examines the process parameters affecting biop printing and bioink-biomaterials and concludes with the future perspective of biopprinting technology.

562 citations

Journal ArticleDOI
TL;DR: The past and recent advances in biomaterial ink development and design considerations moving forward are highlighted and a brief overview of 3D printing technologies focusing on ink design parameters is also included.
Abstract: Three-dimensional (3D) printing is becoming an increasingly common technique to fabricate scaffolds and devices for tissue engineering applications. This is due to the potential of 3D printing to provide patient-specific designs, high structural complexity, rapid on-demand fabrication at a low-cost. One of the major bottlenecks that limits the widespread acceptance of 3D printing in biomanufacturing is the lack of diversity in “biomaterial inks”. Printability of a biomaterial is determined by the printing technique. Although a wide range of biomaterial inks including polymers, ceramics, hydrogels and composites have been developed, the field is still struggling with processing of these materials into self-supporting devices with tunable mechanics, degradation, and bioactivity. This review aims to highlight the past and recent advances in biomaterial ink development and design considerations moving forward. A brief overview of 3D printing technologies focusing on ink design parameters is also included.

548 citations

Journal ArticleDOI
TL;DR: Key additive manufacturing methods are first introduced followed by AM of different materials, and finally applications of AM in various treatment options are reviewed.

466 citations

Journal ArticleDOI
01 Jun 2016-Surgery
TL;DR: The development of guidelines to improve the reporting of experience with 3D printing in surgery is highly desirable and the additional cost and the time needed to produce devices by current 3D technology still limit its widespread use in hospitals.

445 citations


Cites background or result from "Three‐dimensional print of a liver ..."

  • ...The rigidity of the models was reported as a disadvantage, because the models could not reproduce accurately the compliance of natural tissues.(15,138,165) In other studies, the fragility of the models was also underlined....

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  • ...We noted that such disappointment often reported for inkjet printing and especially with anatomic models.(15,45,64,112,138,165) The rigidity of the models was reported as a disadvantage, because the models could not reproduce accurately the compliance of natural tissues....

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Journal ArticleDOI
TL;DR: 3D printing from images generated and interpreted by radiologists presents particular challenges, including training, materials and equipment, and guidelines, and the overall costs of a 3D printing laboratory must be balanced by the clinical benefits.
Abstract: While use of advanced visualization in radiology is instrumental in diagnosis and communication with referring clinicians, there is an unmet need to render Digital Imaging and Communications in Medicine (DICOM) images as three-dimensional (3D) printed models capable of providing both tactile feedback and tangible depth information about anatomic and pathologic states. Three-dimensional printed models, already entrenched in the nonmedical sciences, are rapidly being embraced in medicine as well as in the lay community. Incorporating 3D printing from images generated and interpreted by radiologists presents particular challenges, including training, materials and equipment, and guidelines. The overall costs of a 3D printing laboratory must be balanced by the clinical benefits. It is expected that the number of 3D-printed models generated from DICOM images for planning interventions and fabricating implants will grow exponentially. Radiologists should at a minimum be familiar with 3D printing as it relates to their field, including types of 3D printing technologies and materials used to create 3D-printed anatomic models, published applications of models to date, and clinical benefits in radiology. Online supplemental material is available for this article.

444 citations

References
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Journal ArticleDOI
TL;DR: Three-dimensional CT volumetry is useful for size matching in cases of living-related orthotopic liver transplantation and the weight transition of the rats’ livers under preservation in University of Wisconsin (UW) solution indicated that the graft volume seems to decrease during perfusion with UW solution.
Abstract: Background The aim of this study was to clarify the value of three-dimensional computed-tomography (3D-CT) volumetry for size matching in living-donor liver transplantation (LDLT). Methods. 3D-CT volumetry was applied to 25 donors who underwent hepatectomy for a living relative needing an orthotopic liver transplantation. Fifteen patients underwent extended left lobectomy, one patient an extended left lateral lobectomy, and nine patients right lobectomy. 3D-CT imaging was performed with the workstation ZIO M900 (Zio Software Inc., Tokyo, Japan). The estimated volume of the grafts in two-dimensional (2D) and 3D images were compared, and an error ratio was calculated. Results. 3D-CT imaging revealed the anatomy of the hepatic vein bifurcation and the shape of the graft. The error ratio was 12.8±2.3% in 3D, compared with 19.4±2.5% in 2D. As such, 3D-CT volumetry appears to be more exact than conventional 2D-CT volumetry, but volumetry by 3D-CT still produces an error ratio of approximately 13%. The weight transition of the rats' livers under preservation in University of Wisconsin (UW) solution indicated that the graft volume seems to decrease during perfusion with UW solution. Mismatch of the cutting line and volume reduction by dehydration (approximately 5% reduction 1 hour after perfusion) seems to cause the error in 3D-CT volumetry. Conclusions. Three-dimensional CT volumetry is useful for size matching in cases of living-related orthotopic liver transplantation.

123 citations


"Three‐dimensional print of a liver ..." refers background in this paper

  • ...renders volumes as well, and these are essential to the surgical planning and execution process.(6-8) Despite these advantages, 3D imaging has its shortcomings, including the reality that 3D images are examined through a 2-dimensional (2D) computer screen....

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  • ...3D imaging is becoming an important clinical tool for the planning of complex surgeries and is considered superior to conventional 2D imaging for the visualization of anatomical structures.(4-8) A major disadvantage of 3D imaging is the visualization of images through a 2D computer screen, with which a true sense of depth is limited....

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Journal ArticleDOI
TL;DR: Adult‐to‐adult LDLTs were found to be feasible without affecting patient or graft survival and the incidence of small‐for‐size syndrome developed more frequently in patients with cirrhosis.

115 citations

Journal ArticleDOI
TL;DR: A novel image processing technique was evaluated which allows a semi-automatic volume calculation and 3D visualisation of the different liver segments and no significant differences between the presented automatic volumetry and the conventional volumets were observed.
Abstract: The aim of this study was to evaluate a software tool for non-invasive preoperative volumetric assessment of potential donors in living donated liver transplantation (LDLT). Biphasic helical CT was performed in 56 potential donors. Data sets were post-processed using a non-commercial software tool for segmentation, volumetric analysis and visualisation of liver segments. Semi-automatic definition of liver margins allowed the segmentation of parenchyma. Hepatic vessels were delineated using a region-growing algorithm with automatically determined thresholds. Volumes and shapes of liver segments were calculated automatically based on individual portal-venous branches. Results were visualised three-dimensionally and statistically compared with conventional volumetry and the intraoperative findings in 27 transplanted cases. Image processing was easy to perform within 23 min. Of the 56 potential donors, 27 were excluded from LDLT because of inappropriate liver parenchyma or vascular architecture. Two recipients were not transplanted due to poor clinical conditions. In the 27 transplanted cases, preoperatively visualised vessels were confirmed, and only one undetected accessory hepatic vein was revealed. Calculated graft volumes were 1110 +/- 180 ml for right lobes, 820 ml for the left lobe and 270 +/- 30 ml for segments II+III. The calculated volumes and intraoperatively measured graft volumes correlated significantly. No significant differences between the presented automatic volumetry and the conventional volumetry were observed. A novel image processing technique was evaluated which allows a semi-automatic volume calculation and 3D visualisation of the different liver segments.

98 citations


"Three‐dimensional print of a liver ..." refers background in this paper

  • ...renders volumes as well, and these are essential to the surgical planning and execution process.(6-8) Despite these advantages, 3D imaging has its shortcomings, including the reality that 3D images are examined through a 2-dimensional (2D) computer screen....

    [...]

  • ...3D imaging is becoming an important clinical tool for the planning of complex surgeries and is considered superior to conventional 2D imaging for the visualization of anatomical structures.(4-8) A major disadvantage of 3D imaging is the visualization of images through a 2D computer screen, with which a true sense of depth is limited....

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Journal ArticleDOI
TL;DR: Because the magnitude of the donor operation is greater and potentially fraught with serious short and long term morbidity and possibly mortality, the utilization of living-donors for adult liver transplantation raises bio-ethical concerns heretofore not encountered.
Abstract: Adult-to-adult living-donor liver transplantation is the most recent achievement in the evolution of strategies to increase donor organ supply. Justification of the procedure has evolved from increased organ-waiting times, wait-list morbidity and mortality of adult transplant candidates. Successful application of adult-to-adult living-donor liver transplantation mandates unique surgical, medical, and donor considerations as these procedures predispose to unique complications resulting from anatomic variations, technical considerations, and the transplantation of "partial" grafts. Additionally, because the magnitude of the donor operation is greater and potentially fraught with serious short and long term morbidity and possibly mortality, the utilization of living-donors for adult liver transplantation raises bio-ethical concerns heretofore not encountered. This review explores the current state of adult-to-adult living-donor liver transplantation.

72 citations


"Three‐dimensional print of a liver ..." refers background or methods in this paper

  • ...Digital preparation of the STL files was accomplished with Magics software (Materialise) in order to (1) evaluate the intersecting vessels and the biliary structures originating from subtle time/position artifacts between CT/MRI imaging phases and then generate a nonoverlapping geometry, (2) actualize hollowed vascular and biliary structures within the liver parenchyma, (3) construct thin-walled external vessels and biliary structures to accompany the...

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  • ...The growing demand for liver transplantation and the concomitant shortage of cadaveric livers have led to a rise in living donor liver transplantation (LDLT), in which resection of the right or left liver lobe is performed for the purpose of liver transplantation.(2) Living donors are healthy individuals, so ensuring their safety is of paramount importance....

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Journal ArticleDOI
01 Jan 2007
TL;DR: The region-growing method was useful for graft selection and for determining the indication of middle hepatic vein reconstruction in right liver grafts.
Abstract: Background An accurate estimation of preoperative volumetric measurements of the donor liver is essential in living donor liver transplantation. Methods Three-dimensional (3-D) computed tomography (CT) was applied to 56 living donors. 3-D images of the liver were constructed using the region-growing method and the volume of each sector was measured. Results The median volume ratios of the left liver, caudate lobe, right paramedian, and lateral sectors were 34%, 4%, 38%, and 25% of the total liver volume, respectively. The shape of the congestive area in the right paramedian sector was properly demonstrated by 3-D CT. The volume of the region corresponded to 32% of the right liver. The actual volume of the graft correlated well with the estimated graft volume ( n = .86). Conclusions The region-growing method was useful for graft selection and for determining the indication of middle hepatic vein reconstruction in right liver grafts.

49 citations


"Three‐dimensional print of a liver ..." refers background or methods in this paper

  • ...liver model, and (4) divide the liver mesh structure into graft and remnant components on the basis of the proposed surgical resection plane....

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  • ...This information provides a road map, and its accuracy has improved with the introduction of radiological software able to provide 3D visualization of liver structures.(4,5)...

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  • ...3D imaging is becoming an important clinical tool for the planning of complex surgeries and is considered superior to conventional 2D imaging for the visualization of anatomical structures.(4-8) A major disadvantage of 3D imaging is the visualization of images through a 2D computer screen, with which a true sense of depth is limited....

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