Three-Dimensional Printing for Chest Wall Reconstruction in Thoracic Surgery: Building on Experience
20 July 2018
22 December 2018
08 February 2019 (online)
Objectives Patients undergoing surgery for locally advanced lung cancer involving the chest wall require anatomical lung with extensive en-bloc chest wall resection and appropriate reconstruction.
In this proof-of-concept study, we aimed to produce personalized three-dimensional (3D)-printed chest wall prosthesis for a patient undergoing chest wall resection and reconstruction using clinically obtained computed tomography (CT) data.
Methods Preoperative CT scans of three patients undergoing chest wall resection were analyzed and the areas of resection segmented. This was then used to produce a 3D print of the chest wall and a silicone mold was created from the model. This mold was sterilized and used to produce methyl methacrylate prostheses which were then implanted into the patients.
Results Three patients had their chest wall reconstructed using this technique to produce a patient specific prosthesis. There were no early complications or deaths.
Conclusions It is possible to use 3D printing to produce a patient specific chest wall reconstruction for patients undergoing chest wall resection for malignancy that is cost-effective. This chest wall is thought to provide stability in the form of prosthetic ribs as well compliance in the form of an expanded polytetrafluoroethylene patch. Further research is required to measure chest wall compliance during the respiratory cycle and long-term follow-up from this method.
There are no sources of funding for the work to declare.
All authors fulfill the four criteria according to ICMJE. The main contributions are listed below:
JS: Main author of the manuscript; AP: Substantial contributions to the design of the work and acquisition of data for the work; MJ: Drafting the work for important intellectual content; AN: Revising it critically for important intellectual content; AB: Revising it critically for important intellectual content and substantial contributions to the design of the work.
- 1 Schubert C, van Langeveld MC, Donoso LA. Innovations in 3D printing: a 3D overview from optics to organs. Br J Ophthalmol 2014; 98 (02) 159-161
- 2 Ventola CL. Medical applications for 3D printing: current and projected uses. P&T 2014; 39 (10) 704-711
- 3 Cui X, Boland T, D'Lima DD, Lotz MK. Thermal inkjet printing in tissue engineering and regenerative medicine. Recent Pat Drug Deliv Formul 2012; 6 (02) 149-155
- 4 Kiraly L, Tofeig M, Jha NK, Talo H. Three-dimensional printed prototypes refine the anatomy of post-modified Norwood-1 complex aortic arch obstruction and allow presurgical simulation of the repair. Interact Cardiovasc Thorac Surg 2016; 22 (02) 238-240
- 5 Shiraishi I, Yamagishi M, Hamaoka K, Fukuzawa M, Yagihara T. Simulative operation on congenital heart disease using rubber-like urethane stereolithographic biomodels based on 3D datasets of multislice computed tomography. Eur J Cardiothorac Surg 2010; 37 (02) 302-306
- 6 Banks J. Adding value in additive manufacturing: researchers in the United Kingdom and Europe look to 3D printing for customization. IEEE Pulse 2013; 4 (06) 22-26
- 7 Zopf DA, Hollister SJ, Nelson ME, Ohye RG, Green GE. Bioresorbable airway splint created with a three-dimensional printer. N Engl J Med 2013; 368 (21) 2043-2045
- 8 Saijo H, Igawa K, Kanno Y. , et al. Maxillofacial reconstruction using custom-made artificial bones fabricated by inkjet printing technology. J Artif Organs 2009; 12 (03) 200-205
- 9 Riaz SP, Linklater KM, Page R, Peake MD, Møller H, Lüchtenborg M. Recent trends in resection rates among non-small cell lung cancer patients in England. Thorax 2012; 67 (09) 811-814
- 10 Coleman FP. Primary carcinoma of the lung, with invasion of the ribs: pneumonectomy and simultaneous block resection of the chest wall. Ann Surg 1947; 126 (02) 156-168
- 11 Piehler JM, Pairolero PC, Weiland LH, Offord KP, Payne WS, Bernatz PE. Bronchogenic carcinoma with chest wall invasion: factors affecting survival following en bloc resection. Ann Thorac Surg 1982; 34 (06) 684-691
- 12 Trastek VF, Pairolero PC, Piehler JM. , et al. En bloc (non-chest wall) resection for bronchogenic carcinoma with parietal fixation. Factors affecting survival. J Thorac Cardiovasc Surg 1984; 87 (03) 352-358
- 13 McCaughan BC, Martini N, Bains MS, McCormack PM. Chest wall invasion in carcinoma of the lung. Therapeutic and prognostic implications. J Thorac Cardiovasc Surg 1985; 89 (06) 836-841
- 14 Pairolero PC, Trastek VF, Payne WS. Treatment of bronchogenic carcinoma with chest wall invasion. Surg Clin North Am 1987; 67 (05) 959-964
- 15 Stoelben E, Ludwig C. Chest wall resection for lung cancer: indications and techniques. Eur J Cardiothorac Surg 2009; 35 (03) 450-456
- 16 Downey RJ, Martini N, Rusch VW, Bains MS, Korst RJ, Ginsberg RJ. Extent of chest wall invasion and survival in patients with lung cancer. Ann Thorac Surg 1999; 68 (01) 188-193
- 17 Albertucci M, DeMeester TR, Rothberg M, Hagen JA, Santoscoy R, Smyrk TC. Surgery and the management of peripheral lung tumors adherent to the parietal pleura. J Thorac Cardiovasc Surg 1992; 103 (01) 8-12 , discussion 12–13
- 18 Mansour KA, Thourani VH, Losken A. , et al. Chest wall resections and reconstruction: a 25-year experience. Ann Thorac Surg 2002; 73 (06) 1720-1725 , discussion 1725–1726
- 19 McCormack P, Bains MS, Beattie Jr EJ, Martini N. New trends in skeletal reconstruction after resection of chest wall tumors. Ann Thorac Surg 1981; 31 (01) 45-52
- 20 Yushkevich PA, Piven J, Hazlett HC. , et al. User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 2006; 31 (03) 1116-1128
- 21 Meshlab. http://meshlab.sourceforge.net/ Website accessed on 03/11/2017
- 22 Suzuki K, Park BJ, Adusumilli PS. , et al. Chest wall reconstruction using a methyl methacrylate neo-rib and mesh. Ann Thorac Surg 2015; 100 (02) 744-747
- 23 Pastorino U, Duranti L, Scanagatta P. , et al. Thoracopleuropneumonectomy with riblike reconstruction for recurrent thoracic sarcomas. Ann Surg Oncol 2014; 21 (05) 1610-1615
- 24 le Roux BT, Shama DM. Resection of tumors of the chest wall. Curr Probl Surg 1983; 20 (06) 345-386
- 25 Girotti A, Rosa F, Ferrotto M, Girotti P, Pastorino U. Mechanical behavior of a total chest wall prosthesis with rib-like features. Comput Methods Biomech Biomed Engin 2017; 20 (15) 1581-1588
- 26 Oswald N, Senanayake E, Naidu B, Khalil H, Bishay E. Chest wall mechanics in vivo with a new custom-made three-dimensional-printed sternal prosthesis. Ann Thorac Surg 2018; 105 (04) 1272-1276