Use of 3D Printing for Medical Education Models in Transplantation Medicine: a Critical Review

Abstract

Three-dimensional (3D) printing is a process where a physical object is created from a three-dimensional computer model through successive material layering. 3D printing is used in many industries to design and manufacture new products. Creation of training models for use in medical education is now possible via adoption of medical 3D printing. This article presents a critical-realist review of the medical literature evaluating different ways 3D printing has been used to produce training models for medical education, with a special emphasis on transplantation medicine. From the 68 articles identified by this review, three themes emerged: (a) 3D printing of patient-specific models for preoperative planning, (b) printing training devices for direct use in simulation-based medical education, and (c) printing molds for simulation models that are then used to cast non-printable materials such as soft tissues. Only two reports were identified that described the use of 3D printing for education in transplantation medicine. Many opportunities exist for further research and advancement of 3D printing within the field of transplantation medicine.

Appendix

Sixty-eight articles describing 3D printing used for medical education. Authors that only suggested future use of their models in preoperative planning were categorized as “simulation model.” If the authors used a mold, despite using the model for either simulation, or preoperative planning, the article was categorized as “mold making.”

Reference	Article Summary	Specialty	Use of 3D Printing
Akiba et al. [9]	Created 3D printed bronchi and associated pulmonary vessels from a CT scan to help planning in a patient with anomalous bronchial anatomy prior to thoracosopic surgery to remove a lung tumor.	Thoracic Surgery	Pre-Op
Hughes et al. [24]	Printed models of two patients’ acetabular anatomy to assist surgical decision-making before revision hip arthroplasty. Screw trajectory simulation was also carried out on the models.	Orthopedic Surgery	Pre-Op
Kang et al. [21]	3D printed craniofacial anatomy of a patient to plan a corrective surgery for a prognathic mandible with right deviation.	Maxillofacial Surgery	Pre-Op
Kurenov et al. [42]	Printed pulmonary artery trees from 10 normal patients to facilitate anatomic study and surgical planning of lobectomy. Researchers used the models to design a catheter to give regional chemotherapy.	Thoracic Surgery	Pre-Op
Kusaka et al. [31•]	Developed a kidney graft and pelvic cavity replica as a patient-specific 3D model for living kidney transplantation.	Transplantation Medicine	Pre-Op
Lethaus et al. [12]	3D printed models of 20 patients’ mandibles to adapt reconstruction plates prior to mandibular resection and reconstruction surgery.	Maxillofacial Surgery	Pre-Op
Levine et al. [22]	Used 3D printed models in presurgical planning of four different patients including mandibular tumor resection and fibular flap reconstruction, repair of skeletofacial abnormalities, maxillofacial trauma, and posttraumatic TMJ ankylosis.	Maxillofacial Surgery	Pre-Op
Liu et al. [23]	Printed 3D model of a patient’s mandible and fibular bone which was used as a reference to plan a fibular grafting during a mandibular reconstruction following tumor resection. Although the article focused on one patient’s surgical results, 15 patients with mandibular reconstructions using the methodology.	Maxillofacial Surgery	Pre-Op
Maddox et al. [43]	Created 3D models of 12 patient’s kidneys with suspicious masses for trainees to visualize and understand surgical resection.	Urology	Pre-Op
Miyazaki et al. [44]	Created 3D printed bronchial model for airway stenting insertion practice before performing the procedure on the patient with a single lung transplant complicated by stenosis of the intermediate bronchus.	Thoracic Surgery	Pre-Op
Nakada et al. [14]	Used a 3D printed model of the bronchovascular anatomy from CT scans of patient with lung cancer before thoracoscopic resection.	Thoracoscopic Surgery	Pre-Op
Rondinoni et al. [28]	Produced a model that represented the brain and face segment of a child with Sturge-Weber syndrome for presurgical planning.	Neurological Surgery	Pre-Op
Rose et al. [45]	Created a 3D model of a child’s temporal bone to perform pre-operative simulation and planning of a tympano-mastoidectomy for a recurrent cholesteatoma.	Otolaryngology	Pre-Op
Schmauss et al. [19]	3D printed models for surgical planning of a patient with a right ventricular cardiac fibroma to decide the best surgical approach (partial resection, total resection, or heart transplant).	Cardiac surgery	Pre-Op
Schmauss et al. [20]	Printed a model of a patient with severe aortic stenosis and a porcelain aorta who died after transcatheter aortic valve replacement for evaluation of previous surgical panning.	Cardiac Surgery	Pre-Op
Schwartz et al. [25]	Created rapid prototypes in seven cases of orthopedic surgery for preoperative plan for hip, knee and shoulder arthroplasties, corrective osteotomy and osteochondroma resection.	Orthopedic Surgery	Pre-Op
Silberstein et al. [46]	Created 3D models of five patient’s kidneys with enhancing renal lesions for trainees to visualize before surgical resection.	Urology	Pre-Op
Spottiswood et al. [29]	Created patient-specific 3D scale models of two patients’ brains to indicate the location and extent of a tumor relative to brain surface features and important adjacent structures using functional MRI.	Neurological surgery	Pre-Op
Sugimoto et al. [47]	Created bio-elastic organ and abdominal cavity replication for robotic surgical simulation in 10 patients.	General Surgery	Pre-Op
Tam et al. [26]	3D printed a large scapular osteochondroma in a patient with congenital diaphyseal aclasia to plan the surgical approach.	Orthopedic Surgery	Pre-Op
Tam et al. [48]	3D Printed hollow aortic aneurysm model to determine if complex anatomy was amenable to stenting in a specific patient.	Vascular Surgery	Pre-Op
Tam et al. [49]	3D printed a hollow aortic aneurysm model from a patient with complex anatomy. Simulated the endovascular aneurysm repair before performing the procedure in the patient.	Vascular Surgery	Pre-Op
Tan et al. [27]	Created 3D soft tissue and skeletal models for injured and uninjured hands for preoperative planning in complicated toe-to-hand reconstruction.	Orthopedic Surgery	Pre-Op
Takagi et al. [50]	Printed patient specific liver with intrahepatic cholangiocarcinoma. Compared resected specimen on actual patient to 3D model confirming proper cutting location post hoc.	Surgical Oncology	Pre-Op
Zopf et al. [15]	3D printed the bronchial anatomy of an infant with tracheobronchomalacia created a bioresorbable tracheal splint for insertion into the bronchial tree.	Otolaryngology	Pre-Op
Zein et al. [30•]	Printed models of three sets recipients and donor livers prior to transplant surgery.	Transplantation Medicine	Pre-Op
Barsness et al. [5]	Created 3D printed rib cages for diaphragmatic hernia repair model and trained pediatrics surgeon at a national meeting.	Pediatric Surgery	Simulation Models
Biglino et al. [51]	Printed compliant arterial phantoms for in-vitro studies and device testing of a hypoplastic aorta and a right ventricular outflow tract.	Cardiovascular Imaging	Simulation Models
Bustamante et al. [10]	3D printed two tracheobronchial tree models and connected them to a mannequin for simulation of bronchoscopic anatomy.	Anesthesiology	Simulation Models
Chandrasekhara et al. [52]	3D printed bile duct prototype for teaching and training endoscopic ultrasound guided biliary drainage.	Gastroenterology	Simulation Models
Cheung et al. [35]	Developed 3D printed model of the kidney, renal pelvis, and ureter cast with silicone for pediatric laparoscopic pyeloplasty.	Urology	Simulation Models
Costello et al. [53]	Created five 3D printed cardiac models of common ventricular septal defect based on archived MRIs for teaching medical students.	Cardiology	Simulation Models
Costello et al. [54]	Incorporated five 3D printed cardiac models of ventricular septal defects into a simulation-based congenital heart disease and critical care training curriculum for resident physicians.	Cardiology	Simulation Models
Davis et al. [6]	Created 3D printed thoracoscopic tracheoesophageal fistula repair simulator (model included skin, ribs, and fistula).	Pediatric Surgery	Simulation Models
Davis et al. [7]	Designed a novel thoracoscopic diaphragmatic hernia repair simulator with 3D printing (model included skin, ribs, diaphragm, hernia).	Pediatric Surgery	Simulation Models
Dhir et al. [55]	Created and evaluated a model for training endoscopic ultrasound-guided biliary drainage.	Gastroenterology	Simulation Models
Dimeo et al. [56]	Developed of a surrogate biomodel for the investigation of clubfoot bracing with 3D printing pediatric bones.	Orthopedic Surgery	Simulation Models
Dziegielewski et al. [57]	Created 3D model for complex mandibular reconstruction and surgical simulation training for residents.	Maxillofacial Surgery	Simulation Models
Fasel et al. [58]	Created 3D skull models from cadavers to look at feasibility as a training substitute.	Anatomic Pathology	Simulation Models
Fu et al. [59]	Created anatomy-specific biocompatible drill templates from cadaveric CT scans in preparation for cervical anterior transpedicular screw insertion. The template was tested on the same cadaveric cervical vertebrate from which it was created with success.	Orthopedic Surgery	Simulation Models
Hochman et al. [11]	3D printed a replication of human temporal bone from CT scans for training purposes. Tested 4 different model types for realism during dissection by resident and staff physicians.	Otolaryngology	Simulation Models
Holt et al. [60]	Developed and evaluated of a 3D printed endoscopic ampullectomy training model (stomach, duodenum, ampulla).	Gastroenterology	Simulation Models
Li et al. [16]	Used anatomic corrosion casts of cadavers to create 3D lung models with the bronchial tree, and arteries, and veins.	Anatomic Pathology	Simulation Models
Longfield et al. [36]	3D printed pediatric temporal bone training model for temporal bone surgery including mastoidectomy, facial recess procedures and cochleostomy.	Otolaryngology	Simulation Models
Lu et al. [13]	Created 3D printed cervical pedicle screw templates for training of screw placement on cadaver spines.	Orthopedic Surgery	Simulation Models
McMenamin et al. [61]	Used 3D printing to produce anatomical teaching resources.	Anatomic Pathology	Simulation Models
Nishimoto et al. [62]	Printed 3D mock-up model for chondral framework in auricular reconstruction that can be sterilized and used for planning in the operating room.	Plastic Surgery	Simulation Models
Olivieri et al. [63]	Printed models of eight ventricular septal defects and three peri prosthetic aortic valve leaks using 3D echocardiographic images.	Cardiology	Simulation Models
Rose et al. [17]	3D printed models of temporal bone were created and dissected by otolaryngologists who rated the model for anatomic suitability and realism of operative bone drilling.	Otolaryngology	Simulation Models
Sakuragi et al. [64]	3D printed a biomodel of pulmonary hilum by CT imaging.	Cardiothoracic Surgery	Simulation Models
Salmi et al. [65]	3D printed skull models to determine accuracy of printers.	Maxillofacial Surgery	Simulation Models
Starosolski et al. [66]	Applied 3D printing technology to print the bony anatomy of pediatric musculoskeletal disorders.	Orthopedic Surgery	Simulation Models
Waran et al. [32]	Created cranial models using 3D printing of the nasal cavity, paranasal sinuses, and intrasellar pathology for endoscopic transsphenoidal surgery training.	Neurological Surgery	Simulation Models
Waran et al. [33]	Used 3D printer to create models of the head to enhance the training experience of neurosurgeons when performing craniotomies for tumor resections.	Neurological Surgery	Simulation Models
Waran et al. [34]	Created 3D printed head model with hydrocephalus that was used for neurosurgical endoscopic third ventriculostomy and intraventricular biopsy training.	Neurological Surgery	Simulation Models
Waran et al. [18]	Used patient CT data from three actual patients (one with each of hydrocephalus, a right frontal cortical lesion, and midline clival meningioma) to create 3D printed models used for navigational brain surgery simulations.	Neurological Surgery	Simulation Models
Watson et al. [67]	3D printed multiple patient-specific portal and hepatic venous anatomies for surgical resident education.	General Surgery	Simulation Models
Werner et al. [68]	Manufactured models of fetal malformations built from 3D ultrasound, MRI, and CT scan data.	Pediatrics	Simulation Models
West et al. [69]	Developed a 3D printed model of a spine that could be used for ultrasound imaging and spinal injections.	Anesthesiology	Simulation Models
Hakansson et al. [70]	Created patient specific aorta from a mold after digital removing calcified plaque. The model was used for practicing endovascular stenting of a thoracoabdominal aneurysm.	Vascular Surgery	Mold Making
Hawkinson et al. [41]	3D printed a laparoscopic gastrostomy tube placement simulator (skin, ribs, stomach).	Pediatric Surgery	Mold Making
Hawkinson et al. [8]	3D printed molds of tissue replicas for simulation of rare neonatal congenital defects including esophageal atresia, duodenal atresia and tracheoesophageal fistulas.	Pediatric Surgery	Mold Making
Mashiko et al. [71]	Created 3D models of skulls, cerebellum, and blood vessels for simulating microvascular decompression for hemifacial spasms in seven patients.	Neurological Surgery	Mold Making
Mashiko et al. [72]	Developed 3D printed hollow elastic model for cerebral aneurysm clipping simulation before surgery on 12 patients.	Neurological Surgery	Mold Making
O’Reilly et al. [73]	Fabricated 3D printed anatomical models of the lower limb for anatomical teaching and femoral vessel access training.	Interventional Radiology	Mold Making
Stone et al. [38]	Created 3D printed molds of a left kidney, renal artery/vein, pelvicalyceal system, great vessels, and tumors to train surgeons on operative techniques.	Urology	Mold Making
Turney et al. [39]	Built an anatomically accurate human renal collecting system by 3D printing CT urograms. The models were created for training in fluoroscopy-guided percutaneous nephrolithotomy access.	Urology	Mold Making
Wurm et al. [74]	Created cerebrovascular biomodel for aneurysm surgery clipping training.	Neurological Surgery	Mold Making