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Application of 3D Printing Model and Hepatic Resection Guide Plate in Liver Cancer Surgery
Recently, a patient has undergone a surgery under the virtual guidance provided by the early 3D model reconstruction and 3D printing technology in the Department of Hepatobiliary and Intestine Surgery of Hunan Cancer Hospital. The surgery has lasted for only two hours, with the only 100 ml bleeding amount. It is unimaginable in the previous liver cancer surgeries.
3D Model Construction
Based on the early 3D model reconstruction and 3D printing technique, the Department of Hepatobiliary and Intestine Surgery of Hunan Cancer Hospital has designed a hepatic resection guide plate under the guide of the 3D model-3D printed liver resected plate. At present, 3D printed liver resected plate technology has been successfully applied for patents. The theory of this patented technique is to reconstruct 3D liver model by a detailed and accurate preoperative imaging, and to analyze the tumor’s position and its relationship with the adjacent blood vessels in the model. Then, conduct computerized surgery simulation and design the incisal margin. And then, the resected liver specimen is taken out alone, to design the hepatic resection guide plate that matches the liver surface completely in accordance with the shape of the specimen. Based on the guide plate, the guidance plate printed using high-temperature sterilized synthetic materials is called the 3D printed liver resected plate. This plate is placed on the liver surface during the surgery after it is sterilized, thus a pre-cutting line consistent with that in the simulated surgery is scheduled to determine the accuracy of the surgical resection path.
Application of 3D Printed Liver Resected Plate in Surgery
This technology has maximally conserved residual hepatic tissues on the premise of full resection of liver tumors and quality surgical margins, achieving a satisfactory result. Significantly reduced Bleeding, the postoperative renal function recovers well with excellent surgical margin.
Comparison of the Resected Tumor and the 3D Printed Model
Our country has witnessed high incidence of primary hepatic cancer, each year with nearly 50% hepatic cancers newly occurred in our country. Hepatitis B and hepatitis C virus infection are high-risk causes of the most common primary liver cancer in China. Studies have shown that in China, about 90% of patients with primary liver cancer have experienced hepatitis virus infection; and among which about 60% have a varying degree of cirrhosis. The compensatory capacity of normal liver is quite remarkable. It is believed that it’s quite safe to resect nearly 70% of the liver because the rest 30% can satisfy the body’s needs for metabolism. However, for patients with cirrhosis, their liver function has been reduced greatly. Therefore, there exists such a contradiction in primary liver cancer surgeries: on one hand, doctors hope to expand the resection which means to completely resect the liver tumor and its adjacent liver tissues; on the other hand, they hope to retain the normal tissues as much as they can, which is conducive to the postoperative recovery and to reduce the risk of liver failure. Studies have shown that if the margin of primary liver cancer surgery is 1 cm, the probability of negative margin will be nearly 90%, and if it is 2 cm, the probability is close to 100%. However, it is difficult to determine the distance between the margin on the liver surface and the tumor, which is generally judged by the surgeon based on his/her experience. There is always a certain deviation in these judgements, especially when dealing with tumor located in the deep place of the liver parenchyma, in which case, the tumor location is hard to be accurately felt. Even with the intraoperative B-ultrasound as a 2-dimensional imaging device, it is still hard to provide an accurate pre-cutting line. Therefore, we often find that the surgical margin may be influenced by small lesion during the postoperative pathological examination, while blindly expand the margin may cause the serious consequence of liver failure. 3D printing technology has changed all.
Wu Feiyue, the director of the Department of Hepatobiliary and Intestine Surgery has remarked that the department has operated nearly 100 surgeries employed the 3D printed model technology, including liver surgery, pancreatic surgery, biliary surgery, duodenal surgery and so on. The surgery involving 3D printing technology is very accurate, maximally conserving the normal tissues. Intraoperative blood transfusion can be avoided; it facilitates the surgery rehabilitation and reduces complications. The safety degree has been increased greatly. Liang Jianping, vice president of our hospital, said the hospital would support that technology by collaboratively applying for the relevant scientific research projects in Hunan Province, research centers, etc. In this way, the in-depth research and promotion of this technology will be conducted, embracing wider application, enabling more and more departments and doctors to use this technology. We hope that the use of 3D printing technology in surgeries will benefit more and more patients.