Personalized 3D kidney model produced by rapid prototyping method and its usefulness in clinical applications

ABSTRACT Background: Three-dimensional (3D) printing has been introduced as a novel technique to produce 3D objects. We tried to evaluate the clinical usefulness of 3D-printed renal model in performing partial nephrectomy (PN) and also in the education of medical students. Materials and Methods: We prospectively produced personalized renal models using 3D-printing methods from preoperative computed tomography (CT) images in a total of 10 patients. Two different groups (urologist and student group) appraised the clinical usefulness of 3D-renal models by answering questionnaires. Results: After application of 3D renal models, the urologist group gave highly positive responses in asking clinical usefulness of 3D-model among PN (understanding personal anatomy: 8.9 / 10, preoperative surgical planning: 8.2 / 10, intraoperative tumor localization: 8.4 / 10, plan for further utilization in future: 8.3 / 10, clinical usefulness in complete endophytic mass: 9.5 / 10). The student group located each renal tumor correctly in 47.3% when they solely interpreted the CT images. After the introduction of 3D-models, the rate of correct answers was significantly elevated to 70.0% (p < 0.001). The subjective difficulty level in localizing renal tumor was also significantly low (52% versus 27%, p < 0.001) when they utilized 3D-models. Conclusion: The personalized 3D renal model was revealed to significantly enhance the understanding of correct renal anatomy in patients with renal tumors in both urologist and student groups. These models can be useful for establishing the perioperative planning and also education program for medical students.

摘要
背景：三维（3D）打印作为一种新型三维物体制备技术已得到临床应用。本研究旨在评估3D打印肾脏模型在肾部分切除术（partial nephrectomy，PN）中的临床应用价值，以及其在医学生教育中的作用。
材料与方法：本研究前瞻性地为10例患者基于术前计算机断层扫描（computed tomography，CT）图像通过3D打印技术制备个性化肾脏模型。分别由泌尿外科医师组与医学生组通过填写问卷对3D肾脏模型的临床应用价值进行评估。
结果：应用3D肾脏模型后，泌尿外科医师组对其在肾部分切除术中的临床价值给出了高度积极的评价：个体化解剖结构理解评分8.9/10、术前手术规划评分8.2/10、术中肿瘤定位评分8.4/10、未来进一步应用计划评分8.3/10、完全内生型肿瘤的临床应用价值评分9.5/10。医学生组仅通过解读CT图像定位肾肿瘤时，准确率为47.3%；引入3D模型后，该准确率显著提升至70.0%（p < 0.001）。医学生仅解读CT图像时，主观认为肾肿瘤定位存在难度的比例为52%；使用3D模型后，该比例显著降至27%，差异具有统计学意义（p < 0.001）。
结论：个性化3D肾脏模型可显著提升泌尿外科医师与医学生对肾肿瘤患者肾脏解剖结构的正确认知。该模型可用于围手术期规划制定，同时亦可应用于医学生的教育培训工作。