Pre-Surgical Planning Using Patient-Specific 3D Printed Anatomical Models for Women with Uterine Fibroids

STUDY OBJECTIVE: To evaluate the effect of using patient specific 3D printed anatomical models in pre-surgical planning for patients with uterine fibroids. DESIGN: Repeated measures questionnaire study. SETTING: Tertiary academic hospital. PATIENTS OR PARTICIPANTS: Minimally invasive gynecologic surgeons. INTERVENTIONS: Surgeons completed a questionnaire documenting their surgical plan, perceived surgical difficulty, and confidence in surgical approach before and after receiving a patient specific 3D printed model derived from standard of care pelvic MRI. 3D models had uterine fibroids printed in opaque magenta, endometrium in cyan, and non-neoplastic anatomy (myometrium and cervix) was printed as clear resin to maximize visualisation of underlying lesions. A post-operative questionnaire rated the surgeons’ experience using the 3D models. MEASUREMENTS AND MAIN RESULTS: Five surgeries (4 open myomectomy; 1 laparoscopic hysterectomy) were completed. One staff surgeon and one/two surgical fellow(s) participated in each case (N=11). After viewing the models, perceived surgical difficulty increased in 5, decreased in 1, and did not change in 5 surgeon responses. The average allotted surgical time changed by 50mins and anticipated blood loss by 120cc. Anticipated intra-operative complications changed in 7/11 plans corresponding with a change in planned hemostatic techniques to be used in 6/11 plans. Increased confidence in planned approach was reported in 7/11 surgeon responses. Intra-operative reference changed the operative course in 3/5 surgeries. On average, surgeons rated their experience 8.3/10 for pre-surgical planning, 8.0/10 for intra-operative reference (10=greatest experience), and 7/11 surgeon responses indicated that the models were perceived to have a positive impact on surgical outcomes. CONCLUSION: The use of patient specific 3D printed models altered the surgeons’ perception of surgical difficulty, planned hemostatic techniques, and perceived risk for surgical complications when creating their pre-operative plan. By increasing their understanding of complex anatomy, surgeons reported greater confidence in their pre-operative plan when using 3D models, thus optimizing surgical decision making and improve patient outcomes.