Abstract
The anatomy of the superior mesenteric vessels is complex, yet important, for right-sided colorectal surgery. The usefulness of three-dimensional (3D) printing of these vessels in right hemicolon cancer surgery has rarely been reported. In this prospective clinical study, 61 patients who received laparoscopic surgery for right hemicolon cancer were preoperatively randomized into 3 groups: 3D-printing (20 patients), 3D-image (19 patients), and control (22 patients) groups. Surgery duration, bleeding volume, and number of lymph node dissections were designed to be the primary end points, whereas postoperative complications, post-operative flatus recovery time, duration of hospitalization, patient satisfaction, and medical expenses were designed to be secondary end points. To reduce the influence of including different surgeons in the study, the surgical team was divided into 2 groups based on surgical experience. The duration of surgery for the 3D-printing and 3D-image groups was significantly reduced (138.4 ± 19.5 and 154.7 ± 25.9 min vs. 177.6 ± 24.4 min, P = 0.000 and P = 0.006), while the number of lymph node dissections for the these 2 groups was significantly increased (19.1 ± 3.8 and 17.6 ± 3.9 vs. 15.8 ± 3.0, P = 0.001 and P = 0.024) compared to the control group. Meanwhile, the bleeding volume for the 3D-printing group was significantly reduced compared to the control group (75.8 ± 30.4 mL vs. 120.9 ± 39.1 mL, P = 0.000). Moreover, patients in the 3D-printing group reported increased satisfaction in terms of effective communication compared to those in the 3D-image and control groups. Medical expenses decreased by 6.74% after the use of 3D-printing technology. Our results show that 3D-printing technology could reduce the duration of surgery and total bleeding volume and increase the number of lymph node dissections. 3D-printing technology may be more helpful for novice surgeons.Trial registration: Chinese Clinical Trial Registry, ChiCTR1800017161. Registered on 15 July 2018.
Highlights
With the introduction of the concept of complete mesocolic excision (CME), lymph node dissection in laparoscopic surgery has become more standardized, and the effect of surgical treatment on colon cancer has improved[1,2]
The superior mesenteric vessels can be printed within 24 h after the computed tomography (CT) data are submitted before surgery
Does 3D-printing technology based on 3D-CT angiography have obvious advantages over 3D-CT angiography? The results of this study showed that both 3D printing and 3D imaging are good for surgery, but the effect of 3D printing is more apparent
Summary
With the introduction of the concept of complete mesocolic excision (CME), lymph node dissection in laparoscopic surgery has become more standardized, and the effect of surgical treatment on colon cancer has improved[1,2]. The Henle trunk and right colonic and ileocolic artery and vein present important anatomical differences[7,8,9] This increases the difficulty of the surgery, and, the time required for a novice surgeon to learn the surgical technique. CT angiography, CT colonography, and image fusion technology have seen great progress and have been used in the preoperative evaluation of colon c ancer[11,12,13] These imaging techniques can provide information regarding the right half of the colon, including the vascular anatomy and variations, which can be helpful for CME s urgery[14,15]. We compared the effects of a preoperative 3D-printed model and 3D reconstruction image on laparoscopic right hemicolon cancer surgery and assessed the usefulness of 3D printing of the superior mesenteric vessels for this type of surgery
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