Use of 3D Model in Laparoscopic Myomectomy

Abstract

Video Objective The objective of this video is to review the utility of patient-specific 3D printed models of the uterus in surgical planning and as an intraoperative visual aid in laparoscopic myomectomy. Setting Patients undergoing a laparoscopic myomectomy with the Minimally Invasive Gynecologic Surgery department at Brigham and Women's Hospital were prospectively identified. Women with three or more fibroids and a preoperative MRI for their planned laparoscopic myomectomy were approached for the study, and verbal consent was obtained. Models were printed for three patients in the series, and one case is reviewed in detail in this video. Interventions MRI of the pelvis was acquired for each patient. The DICOM images resulted from the MRI were converted to Standard Tesselation Language (STL), using image segmentation and postprocessing software (Mediprint, Chester, NY). The STL file was printed using a 3D printer (PolyJet J750; Stratasys, Eden Prairie, MN). The models are printed in a clear polymer with fibroids selectively colorized. Transverse slices allow visualization of the intramural extent of fibroids. The models were provided to surgeons for preoperative planning and were also available to the surgeon intraoperatively. Intraoperatively, the models were manipulated outside the sterile field by the research assistant. Conclusion 3D printing is a developing technology with potential for use in surgery. In laparoscopic myomectomy, patient-specific 3D models present an additional tool for preoperative and intraoperative planning. Primary uses include planning of hysterotomies, assessment of the depth of myometrial involvement and proximity to the uterine cavity, and intraoperative identification of fibroids which are not visible or palpable laparoscopically. Additionally, the 3D model can serve as an educational tool for patients and trainees. Currently cost and the time to print 3D models are limiting factors for widespread use. As this technology develops, 3D printing may become a more promising surgical tool.