A Three-Dimensional Printed Tool for Precise and Easy Umbilical Identification during Abdominoplasty.

Abstract

The umbilicus, albeit small, holds significant aesthetic value as the focus of the abdomen.1 The attention paid to this structure during abdominoplasty is of high importance and it can be challenging or time-consuming to relocate the umbilical stalk without efficient tools or techniques. The authors propose a simple technique that uses an inexpensive, three-dimensional printed tool to permit quick and accurate location of the umbilical stalk before creation of the opening for the new umbilicus. The tool resembles a hollow, bottomless pyramid with a 3.5 cm base length. A pyramidal design offers an apex that can be palpated without collapsing under pressure. Its hollow quality allows lateral collapsibility for easy removal. The tool has suture tabs and slots to pass a suture through and allow for securing to the fascia. The tools were printed on an Original Prusa SL1 3D printer using 85A TPU Flexible Filament 1.75 mm with 0.3 mm layer at 465ºF. The tools were steam-sterilized with appropriate controls in autoclave. Versions of the tool with adjusted dimensions were used in heavier patients whose skin thickness necessitated a more prominent marker of the enclosed umbilical stalk. After muscle plication, the tool was placed on top of the umbilical stalk, enclosing it. A single 3-0 polydioxanone suture stitch was secured through the pyramid’s slots and suture tabs. [See Video 1 (online), which demonstrates the pyramid enclosing the umbilical stalk.] The superior abdominal skin flap was then lowered into position, trimmed, and secured inferiorly at the suprapubic incision site with sutures. The location for the opening of the new umbilicus was then attempted through palpation along the abdominal skin flap’s midline. [See Video 2 (online), which demonstrates palpation and detection of the tool.] The concealed apex was definitively located where the opening for the new umbilicus was created. The tool’s securing suture was removed and the collapsible sides were pinched in order to remove the tool easily from the body. [See Video 3 (online), which demonstrates the tool’s flexibility during extraction from the opening.] The umbilical stalk was in the exact spot of the new umbilicus, which was inset in the usual fashion. The tool was discarded after a single use. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"The tool is sutured and secured to fascia around the umbilical stalk. In this video, the surgeon demonstrates the first step in using the three-dimensional printed tool during an abdominoplasty. He has sutured the tool to the fascia around the exposed umbilical stalk.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_e5cicw3s"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 2.","caption":"Vertical stability aids in palpation and detection. In this video, the surgeon demonstrates how the tool is resistant to a reasonable amount of vertical pressure. This vertical stability is advantageous when detecting the concealed apex of the tool during palpation of its overlying abdominal skin, which has since been lowered back into its natural position.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_l7b4dzpe"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 3.","caption":"Horizontal flexibility allows for easy extraction from the abdomen. In this video, the surgeon demonstrates the tool’s horizontal (or lateral) flexibility. It collapses easily and deforms laterally when pressure is applied only to its sides. Once the new umbilical opening is created, the tool has served its purpose and can now be pinched laterally in order to extract it easily from the created hole.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_fhdte4p6"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Other tools with a similar purpose are not as easily produced or effective in diverse patient populations, unlike our tool’s thoughtful design and open source that readily allows customization.2,3 This tool was used successfully in 12 abdominoplasties using progressive tension sutures.4 There were no complications or infections from the use of the tool. A spool of filament, which can print 200 to 250 pyramids, each taking 1 to 2 minutes to print, costs less than $30. The ability to create this tool using only a computer and three-dimensional printer represents an affordable and efficient way to locate the new umbilical opening, saving the surgeon time while achieving a more desirable aesthetic outcome. PATIENT CONSENT The patient provided written informed consent for use of the patient’s images. ACKNOWLEDGMENTS The authors would like to acknowledge the craftsmanship of Brian Mirth and Austin Mirth and thank them for assistance in designing and printing this surgical tool. DISCLOSURE The authors have no conflict of interest or financial interest to declare in relation to the content of this article.