Three-dimensional printing models in surgery

Abstract

A 71-YEAR-OLD WOMAN presented with left shoulder and back pain. She was found to have a T4N0 (stage IIIa) left superior sulcus lung adenocarcinoma (the Fig 1) and underwent neoadjuvant chemoradiation. After completion of treatment, staging computed tomography scan showed significant response of the tumor, which at that time seemed to destroy large portions of the left first and second ribs with abutment onto the subclavian vessels, aorta, the left upper lobe pulmonary artery and the left superior pulmonary vein. Superior sulcus tumors can be approached from 2 different directions: an anterior approach using hemi-clamshell thoracotomy with or without neck incision or via a posterior approach using a posterolateral thoracotomy. The abutment of the tumor to major vascular structures might make an anterior approach preferable (it allows better vascular access and control compared with a posterior approach), but would make the posterior paraspinal dissection difficult. In contrast, the invasion and destruction of the first 3 ribs would be easily approached through a posterolateral