Assisting Difficult Liver Operations Using 3D Printed Models
, Vasileios Papadopoulos 1, Maria Alexiou 1, Ion-Anastasios Karolos 3, Christos Pikridas 3 and Vassilios Tsioukas 3,*Round 1
Reviewer 1 Report
In this study, authors develop a 3D liver model, which could assists visualizing the tumor site in the live cancer. Such model could be useful for surgical procedure and patient family education and training for the resident doctors. The draft is well written, however, there are some serious concerns with the manuscript that needs to be addressed before a decision can be made on this manuscript. My comments are appended below
Abstract
Please rephrase last sentence as `A model of this type has been used for rehearsals of difficult surgical procedures, as well as for training students and specialty doctors at our university` as in current form some grammatical glitches appear.
Introduction
Line 39-42, sentence `The reasons are many and perhaps the main one is the reduction of the cost of both consumables and the 3D printing devices and the wide availability of open-source specialized software that are necessary for the production of 3D printing `needs a suitable reference, please cite a recent report on the topic lately published in ACS Sustainable Chemistry & Engineering https://doi.org/10.1021/acssuschemeng.1c02589 where authors for the first time covered multifaceted topics including why 3D printing is so popular lately to support the statement.
Line 47-54, all details about project/funding, proposal code and other details mentioned therein must be shifted to materials and method section. Author should briefly mention that this study part of the EU proposal for 3D liver printing and imaging modality development in introduction.
Materials and method
In connection with Figure 6. Position of the tumor in-patient as shown before the resection as shown (a), I do not see any ethical committee approval and consent details in materials and method, please add those details.
Figure
I found figure captions too short to understand the figure description. Figure caption must be self-explanatory and authors are encouraged to rewrite all figure caption with a short title and then detail description to comprehend it better.
For example, Figure 7. Complete model of liver anatomy, what are other color in the figures and how the parenchyma marked in green can be distinctly visualized, needs better descriptions.
Similarly, Figure 8. Resected tumor and the tumor model, authors must flag different objects appear in figure.
In Figure 1, can author flag with the asterisk (*) the similar density of the hepatic parenchyma and adjacent tissues in the muscles, which author state that is a significant problem in the isolation of the organ and the creation of its 3D model? What are those color-coding (blue-red)?
Figure 2 is from liver in cross section as visualized based on arterial phase of the organ. Since this figure depicts the liver as single organ, please correct the figure labelling `…by delineating liver boundaries from neighboring organs `. It must be `by delineating liver boundaries from neighboring tissue. `
I suggest authors to combine the figure 4-5 to comprehend it better and make the manuscript compact.
Line 100-102; sentence needs a suitable reference to support the statement.
Cite a latest report https://doi.org/10.1002/adhm.202100633 on the topic with the sentence `For this reason, artificial intelligence and deep learning techniques were used to extract the models of both of the parenchyma but also of the organ pathology (i.e. tumors, hemangioma, etc).` In this report authors proposed machine learning and artificial intelligence to delineate boundaries of internal organ (inhalation route from lungs and allied GIT organs)
There appear punctuation and grammatical errors which needs to be thoroughly checked in the whole manuscript.
Authors must provide a list of all abbreviation used in manuscript as some of abbreviation are not explained in the manuscript.
Author Response
Authors would like to thank the reviewer for his valuable suggestions. Please see below:
Response to Reviewer 1 Comments
Point 1:
Abstract
Please rephrase last sentence as `A model of this type has been used for rehearsals of difficult surgical procedures, as well as for training students and specialty doctors at our university` as in current form some grammatical glitches appear.
Response 1:
Appropriate change has been applied according to the reviewer’s suggestion
Point 2:
Introduction
Line 39-42, sentence `The reasons are many and perhaps the main one is the reduction of the cost of both consumables and the 3D printing devices and the wide availability of open-source specialized software that are necessary for the production of 3D printing `needs a suitable reference, please cite a recent report on the topic lately published in ACS Sustainable Chemistry & Engineering https://doi.org/10.1021/acssuschemeng.1c02589 where authors for the first time covered multifaceted topics including why 3D printing is so popular lately to support the statement.
Response 2:
We tried to download a reference paper given under the URL https://doi.org/10.1021/acssuschemeng.1c02589 but there was no response from the doi.org server. The only recent paper published in the ACS Sustainable Chemistry & Engineering journal and probably a good reference was found in https://pubs.acs.org/doi/10.1021/acssuschemeng.0c09413
and has been added in the references’ list.
Point 3:
Introduction
Line 47-54, all details about project/funding, proposal code and other details mentioned therein must be shifted to materials and method section. Author should briefly mention that this study part of the EU proposal for 3D liver printing and imaging modality development in introduction.
Response 3:
Lines 47-54 have been moved as suggested in the materials and method section (lines 119-126). A short description about the funding was added in the introduction (lines 66-67)
Point 4:
Materials and method
In connection with Figure 6. Position of the tumor in-patient as shown before the resection as shown (a), I do not see any ethical committee approval and consent details in materials and method, please add those details.
Response 4:
Proper ethical committee (hospital’s Investigational Review Board) approval and patient’s consent was added in the legend of figure 6 and additionally in lines 156-159 it is mentioned the approval from the Investigational Review Board (IRB) of the hospital where the operations were realized.
Point 5:
Figure
I found figure captions too short to understand the figure description. Figure caption must be self-explanatory and authors are encouraged to rewrite all figure caption with a short title and then detail description to comprehend it better.
Response 5:
All figures’ captions have been edited to be self-explanatory. A short title is given for each one of them.
Point 6:
For example, Figure 7. Complete model of liver anatomy, what are other color in the figures and how the parenchyma marked in green can be distinctly visualized, needs better descriptions.
Response 6:
Figure 7 caption has been edited to support better understanding of the figure providing addiotionally the colors description.
Point 7:
Similarly, Figure 8. Resected tumor and the tumor model, authors must flag different objects appear in figure.
Response 8:
Figure 8 caption has been edited to flag different objects appearing in the image.
Point 9:
In Figure 1, can author flag with the asterisk (*) the similar density of the hepatic parenchyma and adjacent tissues in the muscles, which author state that is a significant problem in the isolation of the organ and the creation of its 3D model? What are those color-coding (blue-red)?
Response 9:
Figure 1 caption has been edited to provide better explanation of the figure. Blue and red colors areas are described.
Point 10:
Figure 2 is from liver in cross section as visualized based on arterial phase of the organ. Since this figure depicts the liver as single organ, please correct the figure labelling `…by delineating liver boundaries from neighboring organs `. It must be `by delineating liver boundaries from neighboring tissue. `
Response 10:
The figure label has been corrected as suggested.
Point 11:
I suggest authors to combine the figure 4-5 to comprehend it better and make the manuscript compact.
Response 11:
Figures 4 and 5 are combined.
Point 12:
Line 100-102; sentence needs a suitable reference to support the statement.
Response 12:
Proper reference is given.
Point 13:
Cite a latest report https://doi.org/10.1002/adhm.202100633 on the topic with the sentence `For this reason, artificial intelligence and deep learning techniques were used to extract the models of both of the parenchyma but also of the organ pathology (i.e. tumors, hemangioma, etc).` In this report authors proposed machine learning and artificial intelligence to delineate boundaries of internal organ (inhalation route from lungs and allied GIT organs)
Response 13:
The suggested reference was added at the end of the sentence.
Point 14:
There appear punctuation and grammatical errors which needs to be thoroughly checked in the whole manuscript.
Response 14:
An extensive editing was applied by native speaker.
Point 15:
Authors must provide a list of all abbreviation used in manuscript as some of abbreviation are not explained in the manuscript.
Response 15:
Unexplained abbreviations were introduced in the document to avoid giving a list of abbreviations.
More specifically the full terms for abbreviations are added in lines: 28, 34 ,81 to the original (already given in the draft) mentioned abbreviations in lines: 38,77,78, 86-87 and 157.
In line 186 .OBJ is the extension of the standard wavefront digital model files and in order not to be confused as abbreviation it has been changed in small letters as .obj.
Reviewer 2 Report
Some results were mixed in the Materials and Method section, making the description unclear in the current manuscript. The Authors should split the results from the Materials and Method section and integrate the results into the Results section.
Author Response
Authors would like to thank the reviewer for his valuable suggestions. Please see below:
Point 1:
Some results were mixed in the Materials and Method section, making the description unclear in the current manuscript. The Authors should split the results from the Materials and Method section and integrate the results into the Results section.
Response 1:
We have moved a big part from Materials and Methods section to Results section as suggested by the reviewer.
Round 2
Reviewer 1 Report
Authors made significant changes to raise the quality of the mansucript. Article can be accepted in current form
Reviewer 2 Report
The authors reply all of my question.
This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.
