Evaluating the potential utility of three-dimensional printed models in preoperative planning and patient consent in gastrointestinal cancer surgery

• Published in: Annals of the Royal College of Surgeons of England Vol. 103; no. 8; pp. 615 - 620
• Main Authors: Povey, M, Powell, S, Howes, N, Vimalachandran, D, Sutton, P
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.09.2021; Royal College of Surgeons
• Subjects: Aged; Attitude of Health Personnel; Authenticity; Consent; Decision making; Digestive System Surgical Procedures; Exports; Female; Gastrointestinal Neoplasms - surgery; Humans; Informed Consent; Likert scale; Male; Middle Aged; Models, Anatomic; Open source software; Pancreas; Patient Education as Topic; Patients; Planning; Preoperative Care; Printing, Three-Dimensional; Questionnaires; Rectum; Stomach; Surgery; Technology; United Kingdom; United Kingdom; Netherlands; Education of patients; Informed consent; Three-dimensional printing; Surgical oncology; Gastrointestinal cancer
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2020.7102

The report from the Royal College of Surgeons of England acknowledges the important role that three-dimensional imaging will play in support of personalised surgical interventions. One component of this is preoperative planning. We investigated surgeons' and patients' perceptions of this evolving technology. Ethical approval was obtained. From a normal computed tomography scan, three-dimensional models of the stomach, pancreas and rectum were rendered and printed on an Ultimaker™ three-dimensional printer. Semi-structured interviews were performed with surgeons and patients to explore perceived model effectiveness and utility. Likert scales were used to grade responses (1 = strongly disagree; 10 = strongly agree) and qualitative responses recorded. A total of 26 surgeons (9 rectal, 9 oesophagogastric, 8 pancreatic) and 30 patients (median age 62 years, interquartile range, IQR, 68-72 years; 57% male) were recruited. Median surgeon scores were effectiveness for preoperative planning, 6 (IQR 3-7), authenticity, 5 (IQR 3-6), likability, 6 (IQR 4-7), promoting learning, 7 (IQR 5-8), utility, 6 (IQR 5-7) and helping patients, 7 (IQR 5-8). Median patient scores were usefulness to the surgeon, 8 (IQR 7-9), authenticity, 8 (IQR 6-8), likability, 8 (IQR 7-8), helping understanding of condition, 8 (IQR 8-9), helping understanding of surgery, 8 (IQR 7-9) and feeling uncomfortable, 1 (IQR 1-4). Median overall decisional conflict score (0 = no; 100 = high) was 22 (IQR 19-28) and decision effectiveness was 25 (IQR 19-30). Overall, patients and surgeons considered that three-dimensional printed models were effective and had potential utility in education and, to a lesser extent, preoperative planning. Patient decisional conflict and effectiveness scores were weighted towards certainty in decision making but had room for improvement, which three-dimensional models may help to facilitate.