Application of 3D printing technology in laparoscopic pancreaticoduodenectomy

Abstract

Objective To explore the application value of 3D printing technology in laparoscopic pancreatoduodenectomy (LPD). Methods Clinical data of 25 patients undergoing LPD assisted by 3D printing technology in the First People's Hospital of Yunnan Province from November 2015 to March 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 17 patients were male and 8 female, aged 31-75 years old with a median age of 54 years old. 13 cases were diagnosed with pancreatic head cancer and 12 cases of periampullary cancer. Preoperative 3D reconstruction was performed and visualization model was established by 3D printing to determine the relationship between tumor location and blood vessels. Surgical plan was virtualized. LPD was performed with intraoperative 3D real-time guidance. The planning, operation, complications and short-term efficacy 3D printing-assisted LPD were observed. The improvement of quality of life before and after operation was statistically compared by rank-sum test. Results 3D printing and virtual surgical planning were performed in all 25 patients. The 3D printing model yielded a detection rate of 100% for pancreas, peripancreatic vessels and lesions. The optimal surgical plan was determined after the optimization and screening of multiple surgical plans. All 25 patients successfully completed LPD without conversion to open surgery. The median operation time was 285(220-350) min and intraoperative blood loss was 450(100-800) ml. No perioperative death, postoperative abdominal infection or hemorrhage occurred. Pancreatic fistula of varying degree occurred in 5 cases including 3 cases of grade A pancreatic fistula and2 cases of grade B, all of which were cured by non-surgical therapies. During the 3-month follow-up, no local tumor recurrence was noted. At postoperative 6 months, 21 patients had excellent quality of life, 2 cases of good quality of life, 1 case of moderate quality of life and 1 case of poor quality of life, significantly improved comparing with 15, 5, 3 and 2 cases before operation (Z=41.600, P<0.05). Conclusions The 3D printing technology can objectively reflect the spatial relationship between lesions and surrounding organs, which plays a practical role in preoperative diagnosis, anatomical localization, virtual surgical planning and providing real-time guidance for intraoperative procedures. Key words: Laparoscopes; Pancreaticoduodenectomy; Imaging, three-dimensional; 3D Printing