The Use of 3D Printing in Fetal Surgery for Surgical Planning: A Scoping Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Study/Source of Evidence Selection
2.3. Data Extraction
3. Results
3.1. Study Selection
3.2. Characteristics of Included Studies
3.2.1. Publication Timeline
3.2.2. Geographic Distribution
3.2.3. Article Types
3.2.4. Study Design and Size
3.2.5. 3D Printing Techniques
3.3. Described Benefits
3.3.1. Open Spina Bifida
3.3.2. EXIT
3.4. Shortcomings
3.4.1. Open Spina Bifida
3.4.2. EXIT
4. Discussion
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. Database Search Strategies
References
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First Author | Title | Study Design | Maternal Age [Years] | Maternal Previous Gestation | Number of Patients | Gestational Age at Imaging [Weeks] | Gestational Age at Surgery [Weeks] | Diagnosis | What Was the Model Primarily Used for | Anatomical Region Modeled | 3D Printing Material/Method | Imaging Method Used | Delivery Method/Age [Weeks] | Fetal Interventions | Described Benefits |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Spina bifida | |||||||||||||||
Miller (2021) [15] | Implementation Process and Evolution of a Laparotomy-Assisted 2-Port Fetoscopic Spina Bifida Closure Program | Clinical Trial | 31.1 ± 7.2 | - | 19 | - | 25.1 [22.9–25.9] | Open Spina Bifida (12 myelomeningocele, 7 myeloschisis) | Surgical Simulator | MMC Defect | Method- Not Specified Materials-Not Specified, Silicone skin covering | Ultrasound | 9/16—vaginal 7/16—cesarean 2/3 unsuccessful cases delivered by emergency cesarean (did not report last case) Median delivery GA was 37 weeks (range 27–39.6) | Fetoscopic OSB closure | The model was felt to be critical in successfully building a cohesive operative team which minimized clinical errors Patient-matched models allowed specific aspects or challenges for each procedure to be better anticipated. Practice sessions allowed the team to improve surgical technique and efficiency |
Handler (2016) [16] | Three-dimensional modeling of fetal myelomeningocele | Case Series | - | - | 9 | - | - | Myelomeningocele | Predict the need for a patch Template to create a patch | MMC Defect | Method- Not specified Material- Acrylonitrile butadiene styrene (ABS) | MRI | - | Myelomeningocele repair with or without patch placement | 3D modeling allowed surgeons to know in advance if a patch would be required. In those that required a patch, early intraoperative patch production for MMC closure, allowed for reduced intraoperative times & complications |
EXIT | |||||||||||||||
Kelle (2017) [17] | Delivery and management of complete ectopia cordis: A multidisciplinary approach | Case report | 25 | - | 1 | - | 36 | Pentalogy of Cantrell and large thoracoabdominal defect | Surgical Planning | Full Body | - | MRI | Cesarean delivery at 36 weeks | EXIT procedure to secure airway | - |
Shalev (2021) [18] | Utility of three-dimensional modeling of the fetal airway for ex utero intrapartum treatment | Case report | 31 | - | 1 | 32 | 38 | Cervical multi-cystic lymphatic malformation | Identify the tongue/glottis position and practice intubation | Mandible, tongue, mass, larynx, and trachea | Method- Stereolithography Material- Not Specified | MRI | Cesarean delivery at 38 weeks | EXIT procedure to secure airway | Clearer understanding of the anatomy and pathology. Increased confidence in surgical plan |
Garcia de Paredes (2022) [19] | Antenatal Three-Dimensional Printing for Ex Utero Intrapartum Treatment Procedures | Case series | 1. 32 2. 22 | - | 2 | 1. 25 4/7 2. 27 4/7 | 1. 37 1/7 2. No intervention | 1. Cervical teratoma 2. Oropharyngeal teratoma | Determine the necessity for EXIT procedure | Face/neck | 1. Fused deposition modeling; unknown material 2. Stereolithography; unknown material | Ultrasound | 1. 37 1/7; cesarean delivery 2. 33 6/7; cesarean delivery | 1. U/S guided needle aspiration, EXIT Procedure to secure airway 2. None | 1. Asses the relationship of mass to airway 2. Model showed no airway obstruction so EXIT procedure was not indicated Increased team confidence in anatomy and foreseen intra-operative interventions |
VanKoevering (2015) [20] | Antenatal Three-Dimensional Printing of Aberrant Facial Anatomy | Case report | 22 | G1P0 | 1 | 32 | - | Protuberant bilateral cleft lip and palate with a prominent anteriorly displaced premaxilla and philtrum | Determine the necessity for EXIT procedure | Face | Fused deposition modeling and stereolithography Unknown material | MRI | Cesarean section | None | Improved visualization of maxillofacial anatomy Hands-on experience allowed the team to plan potential interventions Increased confidence in the anatomy and potential interventions necessary |
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Fils, A.J.; Kasmirski, J.; Okpaise, O.; Reynolds, J.M.; Tonni, G.; Werner, H.; Ruano, R. The Use of 3D Printing in Fetal Surgery for Surgical Planning: A Scoping Review. J. Clin. Med. 2024, 13, 4999. https://doi.org/10.3390/jcm13174999
Fils AJ, Kasmirski J, Okpaise O, Reynolds JM, Tonni G, Werner H, Ruano R. The Use of 3D Printing in Fetal Surgery for Surgical Planning: A Scoping Review. Journal of Clinical Medicine. 2024; 13(17):4999. https://doi.org/10.3390/jcm13174999
Chicago/Turabian StyleFils, Aaron J., Julia Kasmirski, Oluwateniayo Okpaise, John M. Reynolds, Gabriele Tonni, Heron Werner, and Rodrigo Ruano. 2024. "The Use of 3D Printing in Fetal Surgery for Surgical Planning: A Scoping Review" Journal of Clinical Medicine 13, no. 17: 4999. https://doi.org/10.3390/jcm13174999