Three-Dimensional Surgical Planning In Microsurgery

SDCC 

Three-dimensional printing (3DP) has been used in many surgical specialties for virtual surgical planning. A medical image is fed into modeling software, converted to a print file, and then printed from a variety of materials, usually soft or hard plastic. The result is a three-dimensional model of the original image that can be used to guide preoperative and intraoperative decision making. This technology is not currently used commonly for virtual surgical planning in microsurgery.

Virtual and 3D surgical planning strategies in head and neck reconstructive surgery have been shown to result in overall decreased intraoperative decision making, decreased procedure times, and improved microvascular ischemic time in free flaps. In microsurgery, CT-angiography is often used as a proxy to virtual surgical planning to identify major vessels capable of supporting axial flaps. Actual anatomy may differ from the CT-generated images, due to patient volume characteristic, timing of contrast, and operator ability, necessitating a change in intraoperative decision making. 3DP provides a unique opportunity to create accurate 3D replicas of abdominal vasculature for use in surgical planning. These replicas allow for the surgeons to analyze spatial relationships between various anatomical landmarks in ways that purely CTA surgical planning does not. In 2022 Ogunleye et. al demonstrated that 58 breast free flaps performed using 3D printed models as guidelines had no changes in intraoperative decision making, compared to a 24.1% change in operations using standard CTA for surgical planning (1). In addition, 3DP could play a role in mapping nerves in three-dimensional space allowing the surgeon to identify intraoperative landmarks for nerve preservation. 3DP and other methods of virtual surgical planning have already been used in skull base surgery and oral maxillofacial surgery to identify intraoperative landmarks for the purpose of nerve preservation with good success (2-4).

3DP has significant future applications in microsurgery. Implementation of 3DP could reduce intraoperative changes to preoperative plan, decrease overall procedure time, and assist in preserving sensation for patients.

References

1. Ogunleye et. al, The utility of three-dimensional models in complex microsurgical restruction. Archives of Plastic Surgery, 03-22-2022.
2. Hermann et. al, A novel approach to nerve preservation during segmental resection of mandible utilizing virtual surgical planning (VSP): A Case Series
3. Cung et. Al, Preservation of Infraorbital Nerve in Orbital Floor and Maxillary Defect Reconstruction With Patient-Specific Three-Dimensional Implant: A Case Report. Ophthalmic Plastic and Reconstructive Surgery. 38(5):p e136-e141, September/October 2022.
4. Hsu et. al. Computer-Aided Three-Dimensional Virtual Surgical Planning in Complex Skull Base Reconstruction for Sphenoid Wing Dysplasia in Neurofibromatosis Type 1. Journal of Craniofacial Surgery. 32(7):p 2539-2541, October 2021.

Research and Technology

PSTM 2024