Razi Journal of Medical Sciences

fa مروری برتکنولوژی چاپ سه بعدی و کابربردهای آن در جراحی A review of 3D printing technology and its applications in surgery پزشکی Medical مروري review article زمینه و هدف: رشد چشمگیر تکنولوژی چاپ سهبعدی در سالهای اخیر موجب کاربرد این فناوری نوین در بسیاری از زمینههای پزشکی شده است بهطوریکه مطالعات انجام شده در دهههای اخیر نشاندهنده اهمیت ویژه این تکنولوژی در بهبود عملکرد بسیاری از روشهای درمانی میباشد. از آنجا که جراحی یکی از اصلیترین روشهای درمان در حوزه پزشکی محسوب میشود، ظهور تکنولوژی چاپسه بعدی در زمینه جراحی و ایجاد قسمتهای مختلف بدن بیمار، موجب بهبود عملکرد جراح و افزایش سطح دقت و کیفیت جراحی خواهد شد. در واقع از آنجا که جراحیهای پیچیده جهت اطمینان از موفقیتآمیز بودن روش درمانی به کاررفته نیازمند درک بصری دقیقتر قبل از عمل بوده، تکنولوژی چاپ سهبعدی میتواند بهعنوان یک روش نوید بخش برای تولید مدلهای دقیقتر، سریعتر و ارزانتر در نظر گرفته شود. علاوه براین، امکان تولید محصولات بسیار تخصصی برای طیف گستردهای از بیماران توسط فرآیند چاپ سهبعدی، به عنوان انقلابی در علم و همچنین صنعت شناخته شود. بنابراین با توجه به اهمیت بیش از پیش فرآیند چاپ سهبعدی در جراحیهای پزشکی، هدف از انجام مطالعه مروری حاضر، بررسی وضعیت فعلی فناوری چاپ سهبعدی و کاربردهای بالینی آن در ایجاد قسمتهای سهبعدی مختلف بدن بیماران با استفاده از دادههای تصویربرداری پزشکی جهت بهکارگیری در فرآیندهای جراحی میباشد. روش کار: برای بررسی کاربردهای تکنولوژی چاپ سهبعدی در جراحی، با جستجو در مقالات نمایه شده در پایگاههای داده فارسی و لاتین Scopus ،PubMed ،Science direct ،Scholar ، در نهایت تعداد 34 مطالعه مرور گردیدند. یافته ها: نتایج مطالعات انجام شده نشاندهنده اهمیت بالقوه تکنولوژی چاپ سهبعدی در جراحی میباشد بهطوریکه می‌تواند منجر به بهبود نتایج درمانی بهدست آمده شود. همچنین از آنجا که وسایل تولیدشده توسط فن‌آوری چاپ سه‌بعدی، متناسب با آناتومی هر بیمار می‌باشد، بکارگیری این وسایل می‌تواند خطاهای مرتبط بهوجود آمده در حین عمل را کاهش دهد. در این مقاله سعی شده است تا کاربردهایی همچون جراحی فک و صورت، ستون فقرات، کبد و ... به طور خلاصه مورد بحث قرار گیرد. شایان ذکر است علاوه بر مزایای بسیار با ارزش این تکنولوژی، میتوان به معایبی همچون محدودیت در اندازه چاپ و هزینهبر بودن فرآیند چاپ اشاره کرد که مطالعات بسیاری سعی در رفع کاستیهای موجود تکنولوژی چاپ سهبعدی در کاربردهای بالینی دارند.   Background & Aims: The considerable growth of 3D printing technology in recent years has led to the application of this emerging technology in many medical fields, in which recently performed studies have shown the special importance of this technology which can enhance the results of the treatment method. Since, surgery is one of the main modalities to treat patients, the advent of 3D printing technology in surgery and the creation of different patient organs with 3D printers, improve the surgeon's performance. Hence, the accuracy and quality of the surgery can be enhanced. The aim of this study was to review the current statues and the applications of the 3D printing technology in surgery. Methods: By searching the indexed articles in Persian and Latin databases, Scopus, PubMed, Science direct, Scholar, 34 studies were reviewed. Results: 3D printing applications in surgery: Generally, the ability to generate a physical object with complex structures from a digital model has been introduced as the 3D printing technology which offers many advantages over the traditional manufacturing. The most important advantage of 3D printing technology is the ability to produce objects based on individual needs in which can reduce the costs of their production. Furthermore, complex preoperative procedures can be practiced. In other words, 3D printed models allow physicians to become familiar with medical procedures which possible problems created during the operation, can be identified before the operation. This modern technology generally includes three main steps to generate 3D objects from imaging data. The first step is the acquisition of image data. Then, the interest region is extracted which is termed as the segmentation. Finally, the digital data is transferred to the 3D printers to produce the 3D object.  For 3D model production, printer selection highly depends on speed, accuracy, cost, and availability of the printing materials. Recent advances in 3D printing technology have made it possible to use various biocompatible materials such as titanium and degradable polyesters to produce 3D models. Complex surgeries require more precise visual understanding before the surgery to ensure about the success of the treatment. In this regard, 3D printing technology can be a promising way to produce faster and cheaper models. In addition, this modern technology enables producers to produce highly specialized products for a wide range of patient organs. Applying a physical model results in better performance and greater visual perception about the desired treatment area, which can significantly reduce the side effects during surgery. Since a large contribution of the surgical process can be performed outside the operating room hence, 3D printed models can reduce the operation time. In fact, before the operation, surgeons will have enough time to make decisions, evaluate solutions and focus on other key elements during the operation. So, based on the basic role of 3D printing technology in surgery, the purpose of the present review is to investigate the current state of 3D printing technology and its clinical application in surgery for the construction of various 3D organs via medical imaging data. In this paper, some applications such as maxillofacial, spinal, liver, etc., are briefly discussed. Maxilla-facial and cranial facial reconstruction are the complex procedure which have been one of the first and most proven applications of 3D printing in the field of surgery to correct the facial deformities after the tumor resection. In this method with the application of 3D printers, at first, a 3D model of the desired anatomy is prepared to reduce a significant amount of time for linking the titanium plates to transplant adjacent bones (while the patient is anesthetized). Also, the production of titanium implants using the 3D printers will result in a very precise fit with the target tissue, the risks of maxillofacial surgery can be reduced. The use of 3D printing applications before or during complex surgeries like congenital heart defects has been reported in several studies. Since, acquiring to the real anatomical structures in patients with complex congenital defects, are sometimes unpredictable, treatment planning and surgical decision-making require a thorough understanding of three-dimensional anatomy. Therefore, the 3D printing technique, as a widely used method in all medical fields can overcome the defects of common preoperative imaging, especially in cardiovascular surgery. The other application of 3D printing technology includes spinal surgery in which due to the complex anatomy of the spine and the delicate nature of the surrounding structures, 3D printers will improve preoperative planning and increase the accuracy during the surgery. Liver surgery can be another suitable candidate for performing 3D printing technology to create 3D printing models. The two main applications of 3D printing technology in this field include training or necessary planning for surgery and liver functional cell printing through bio-printing technology that can be used in the study of liver disease and pharmaceutical research. Renal tumor resection is the other example of 3D printing applications in which 3D models have an exclusive role to enhance the accuracy of renal surgery. The 3D printed models can accurately display three-dimensional spatial relationships between different anatomical and pathological structures. Three-dimensional printed kidney models may also facilitate interdisciplinary communication and decision-making about the management of patients undergoing renal surgery.  In the field of renal surgeries, employing of 3D printed models plays a specific performance to train young surgeons which consequently increases the practical skills of surgeons which can accurately visualize the anatomical and morphological relationship compared to volumetric imaging. The obtained results of performed studies in the field of 3D printing show the potential significance of this technology in surgery which can lead to improvement of therapeutic outcomes. Since the printed models by 3D printing technology have an appropriate fit to the anatomy, the use of these models can reduce the associated errors during surgery. It is worth noting that despite the valuable advantages of this technology, some disadvantages such as limited printing size and costly printing process can be discussed which many studies try to address the deficiency of 3D printing technology in clinical applications. The cost of 3D printed models varies according to the type of performed printing method and applicable software which requires specialized users. The main mentioned costs for 3D model creation include hardware, software, and printed materials. In the future, the production costs of 3D models would be likely reduced in which the use of 3D models would become more traditional in common clinical operation. The 3D printed physical models are based on medical imaging which are prone to errors during the imaging procedures. Hence, increasing the accuracy of creating printed models requires improving the clinical imaging methods. Generally, with the advances in this modern technology, faster, cheaper, and more accurate models can be produced. تکنولوژی چاپ سه‌بعدی, جراحی, نمونه‌سازی سریع, آموزش جراحی, طراحی درمان 3D printing technology, Surgery, Rapid prototyping, Surgical training, Treatment planning 64 75 http://rjms.iums.ac.ir/browse.php?a_code=A-10-5220-1&slc_lang=fa&sid=1 Reza Shamsabadi رضا شمس آبادی rshams220@gmail.com 3900319475328460061856 3900319475328460061856 Yes Hakim Sabzevari University, Sabzevar, Iran دانشگاه حکیم سبزواری، سبزوار، ایران Seyed Hamid Zoljalali Moghaddam سید حمید ذوالجلالی مقدم zoljalali.h@tak.iums.ac.ir 3900319475328460061857 3900319475328460061857 No Iran University of Medical Sciences, Tehran, Iran دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Hamid Reza Baghani حمیدرضا باغانی hamidreza.baghani@gmail.com 3900319475328460061858 3900319475328460061858 No Hakim Sabzevari University, Sabzevar, Iran دانشگاه حکیم سبزواری، سبزوار، ایران Seyed Rabi Mahdavi سید ربیع مهدوی srmahdavi@hotmail.com 3900319475328460061859 3900319475328460061859 No Iran University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی ایران، تهران، ایران