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A systematic review of the application of 3D-printed models to colorectal surgical training

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Abstract

Background

The aim of this review was to explore the role of three-dimensional (3D) printing in colorectal surgical education and procedural simulation, and to assess the effectiveness of 3D-printed models in anatomic and operative education in colorectal surgery.

Methods

A systematic review of the literature was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify relevant publications relating to the use of 3D-printed models in colorectal surgery in an educational context. The search encompassed OVID Medline, Web of Science and EMBASE including papers in English published from 1 January 1995 to 1 January 2023. A total of 1018 publications were screened, and 5 met the criteria for inclusion in this review.

Results

Four distinct 3D models were described across five studies. Two models demonstrated objective benefits in the use of 3D-printed models in anatomical education in academic outcomes at all levels of learner medical experience and were well accepted by learners. One model utilised for preoperative visualisation demonstrated improved operative outcomes in complete mesocolic excision compared with preoperative imaging review, with a 22.1% reduction in operative time (p < 0.001), 9.2% reduction in surgical duration (p = 0.035) and 37.3% reduction in intraoperative bleeding volume amongst novice surgeons (p < 0.01). Technical simulation has been demonstrated in a feasibility context in one model but remains limited in scope and application on account of the characteristics of available printing materials.

Conclusions

3D printing is well accepted and effective for anatomic education and preoperative procedural planning amongst colorectal surgeons, trainees and medical students but remains a technology in the early stages of its possible application. Technological advancements are required to improve the tissue realism of 3D-printed organ models to achieve greater fidelity and provide realistic colorectal surgical simulations.

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Data Availability

The datasets generated during and analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

K.L. would like to acknowledge the financial support of the Australian Government through the professional practice research training scholarship program.

Funding

No other funding was received for the preparation of this manuscript. The material in the manuscript is the original work of the authors and has not been presented or submitted elsewhere for publication.

Author information

Authors and Affiliations

  1. The University of Melbourne, Parkville, VIC, Australia

    Gloria To, Kirsten Larkins, Daniel M. Costello, Satish Warrier, Helen Mohan & Alexander Heriot

  2. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia

    Justin A. Hawke, Kirsten Larkins, Satish Warrier, Helen Mohan & Alexander Heriot

  3. International Medical Robotics Academy, North Melbourne, VIC, Australia

    Grace Burke, Satish Warrier & Alexander Heriot

Authors
  1. Gloria To
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  2. Justin A. Hawke
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  4. Grace Burke
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  5. Daniel M. Costello
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  7. Helen Mohan
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by G.T. and J.H. The first draft of the manuscript was written by G.T. and J.H. who contributed equally to this manuscript and should be considered joint first authors for this publication. All authors commented on previous versions of the manuscript and read and approved the final manuscript.

Corresponding author

Correspondence to Justin A. Hawke.

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The authors declare that they have no conflict of interest. 

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Appendices

Appendix 1: Search strategy

  1. 1.

    3D.mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  2. 2.

    Three-dimensional.mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  3. 3.

    3D model.mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  4. 4.

    Three-dimensional model.mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  5. 5.

    Colorectal*.mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  6. 6.

    Rectal*.mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  7. 7.

    Surg*.mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  8. 8.

    Teaching.mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  9. 9.

    Education.mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  10. 10.

    Sim*.mp. [mp = ti, ab, hw, tn, ot, dm, mf, dv, kf, fx, dq, nm, ox, px, rx, an, ui, sy]

  11. 11.

    5 or 6

  12. 12.

    7 and 11

  13. 13.

    1 or 2 or 3 or 4

  14. 14.

    8 or 9 or 10

  15. 15.

    12 and 13 and 14

  16. 16.

    Limit 15 to English language

  17. 17.

    Limit 16 to yr = “1995-Current”

Web of Science: 667 records identified.

Medline + EMBASE: 570 records identified.

Appendix 2: Newcastle–Ottawa quality assessment scale for the included studies

No.

Criterion

Question

Score (* = 1, no * = 0)

Studies

Bangeas et al. (2019)

Chen et al. (2020)

Hojo et al. (2019)

Hojo et al. (2020)

Yiasemidou et al. (2021)

Selection

     

1

Adequacy of case definition

a) Yes, with independent validation*

b) Yes, e.g., record linkage or based on self-reports

c) No description

a*

a*

a*

a*

a*

2

Representativeness of cases

a) Consecutive or obviously representative series of cases *

b) Potential for selection biases or not stated

a*

a*

a*

a*

a*

3

Selection of controls

a) Community controls*

b) Hospital controls

c) No description

a*

a*

a*

c

a*

4

Definition of controls

a) No history of disease (endpoint)*

b) No description of source

a*

a*

a*

a*

a*

Comparability

     

1

Comparability of cases and controls on basis of design or analysis

a) Study controls for (select the most important factor)*

b) Study controls for any additional factor*

a*

N/A

a*

N/A

a*

Exposure

     

1

Ascertainment of exposure

a) Secure record (e.g. surgical records)*

b) Structured interview where blind to case/control status*

c) Interview not blinded to case/control status

d) Written self-report or medical record only

e) No description

c

c

c

c

c

2

Same method of ascertainment for cases and controls

a) Yes*

b) No

a*

a*

a*

a*

a*

3

Non-response rate

a) Same rate for both groups*

b) Non-respondents described

c) Rate different and no designation

a*

a*

a*

a*

a*

Score:

7

6

7

5

7

Appendix 3: Preferred reporting items for systematic reviews and meta-analyses (PRISMA) diagram of article selection process

figure a

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To, G., Hawke, J.A., Larkins, K. et al. A systematic review of the application of 3D-printed models to colorectal surgical training. Tech Coloproctol 27, 257–270 (2023). https://doi.org/10.1007/s10151-023-02757-7

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  • DOI: https://doi.org/10.1007/s10151-023-02757-7

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