Pre-Surgical Planning Using Patient-Specific 3D Printed Anatomical Models for Women with Uterine Fibroids

Flaxman, T.; Cooke, C. M.; Sheikh, A.; Miguel, O.; Chepelev, L.; McInnes, M.; Singh, S. S.

Study Objective To evaluate the effect of using patient specific 3D printed anatomical models in pre-surgical planning for patients with uterine fibroids. Design Repeated measures questionnaire study. Setting Tertiary academic hospital. Patients or Participants Minimally invasive gynecologic surgeons. Interventions Surgeons completed a questionnaire documenting their surgical plan, perceived surgical difficulty, and confidence in surgical approach before and after receiving a patient specific 3D printed model derived from standard of care pelvic MRI. 3D models had uterine fibroids printed in opaque magenta, endometrium in cyan, and non-neoplastic anatomy (myometrium and cervix) was printed as clear resin to maximize visualisation of underlying lesions. A post-operative questionnaire rated the surgeons’ experience using the 3D models. Measurements and Main Results Five surgeries (4 open myomectomy; 1 laparoscopic hysterectomy) were completed. One staff surgeon and one/two surgical fellow(s) participated in each case (N=11). After viewing the models, perceived surgical difficulty increased in 5, decreased in 1, and did not change in 5 surgeon responses. The average allotted surgical time changed by 50mins and anticipated blood loss by 120cc. Anticipated intra-operative complications changed in 7/11 plans corresponding with a change in planned hemostatic techniques to be used in 6/11 plans. Increased confidence in planned approach was reported in 7/11 surgeon responses. Intra-operative reference changed the operative course in 3/5 surgeries. On average, surgeons rated their experience 8.3/10 for pre-surgical planning, 8.0/10 for intra-operative reference (10=greatest experience), and 7/11 surgeon responses indicated that the models were perceived to have a positive impact on surgical outcomes. Conclusion The use of patient specific 3D printed models altered the surgeons’ perception of surgical difficulty, planned hemostatic techniques, and perceived risk for surgical complications when creating their pre-operative plan. By increasing their understanding of complex anatomy, surgeons reported greater confidence in their pre-operative plan when using 3D models, thus optimizing surgical decision making and improve patient outcomes.