Table 1. Study characteristics of 3D printing in renal disease.
| First author and year of publication | Study sample size | Study purpose | Imaging modalities used for 3D printing | Software used for image segmentation/duration of segmentation | 3D printer/printing materials/costs/printing duration | Key findings |
|---|---|---|---|---|---|---|
| Adams et al. 2017 (24) | 3D printed models of kidney with collecting system based on 3 kidney cadavers | Validation of 3D printed model for surgical procedures | CT (3D cadaveric kidneys were scanned with CT) | InVesalius 3.0.0 (open source software) | 3Z pro (Solidscape, NH, USA) for printing collecting system (wax) | • Mean distance error of model between real organ and CT scan is 1%. Mean error for three phantoms is 0.6 mm |
| Models scaled down to 80% | Objet 260 Connex (Stratasys, Israel) for printing outer molds (photopolymer VeroClear) | • Use of various materials for research and training; use of biocompatible materials for tissue engineering | ||||
| 31 h for printing | ||||||
| 2 days for the whole process (from 3D model to a ready-to-use phantom) | ||||||
| Atalay et al. 2017 (25) | 5 cases with complex renal stones (staghorn renal stone) | Patient-specific 3D printed models for improving patient’s understanding of renal diseases | CT | Mimics 16.0 (Materialise, Belgium) | Fused Deposition Modelling | 3D printed models improve patient’s understanding of basic kidney anatomy, renal stone position, planned surgical procedures and complications associated with the surgery by >50% (P<0.05) |
| Acrylonitrile butadiene styrene (ABS) | ||||||
| USD$100 | ||||||
| 2 h | ||||||
| Bernhard et al. 2016 (15) | 7 patients with renal tumours (size range, 2.5–7.2 cm) | The impact of 3D printed models on patient’s education | CT | Synapse 3D (Fujifilm, Tokyo, Japan) | Objet 500 Connex 3 (Stratasys Ltd., MN, USA) | • Overall improvement in patient’s responses was 37.6% |
| Photopolymer with different colours | • Patient’s understanding of renal anatomy and physiology, and planned surgical procedure was significantly improved after the use of 3D printed models (P<0.05) | |||||
| USD$560 | • Mean rating of patient satisfaction about usefulness of 3D models is 9.4/10 | |||||
| Dwivedi et al. 2017 (26) | 6 patients with renal tumours | Patient-specific 3D printed renal tumour molds for radiomics and radiogenomic analyses | MRI | 3D Slicer (http://www.slicer.org) | Project 3512HD (3D Systems, SC, USA) | • First report of patient-specific 3D printed renal molds to correlate MRI tumour features with renal histopathology |
| Each mold: USD$ 160.7±111.1 | • 3D printed molds provide a new opportunity for future radiomic and radiogenomic studies | |||||
| Entire kidney with a renal tumour: USD$1,000 | ||||||
| 12–14 h for printing a mold | ||||||
| Golab et al. 2016 (27) | 1 case with a giant renal tumour with neoplastic mass in the venous system and right atrium | 3D printing to plan for a rare complicated surgery | CT | NA | Fused Deposition Modelling Euro 100 (USD$123) |
• 3D printed model helped surgical planning and identification of anatomical structures, thus improving safety and reducing the surgery duration |
| 22 h | • Treatment decisions can be expedited with use of 3D physical models to facilitate communication between physicians from different disciplines | |||||
| Golab et al. 2017 (28) | 3 cases with renal tumours with digital models designed for 3D printing | 3D printed kidney models for training in laparoscopic procedures | CT | 3D Slicer (Surgical Planning Lab, Harvard University, MA, USA) | MakerBot Replicator 2 (MakerBot Industries, LCC) | Simulation of surgical procedures based on 3D printed models improves actual laparoscopic surgery and shortens the duration of intraoperative renal ischemia |
| TinkerCAD (Autodesk, San Rafal, CA, USA) | Silicone material Elite Double 8 | |||||
| USD$120 | ||||||
| Printing kidney and tumours: 4 h and 15 min, 55 min, respectively | ||||||
| Total time of production: 7–8 h | ||||||
| Knoedler et al. 2015 (29) | 6 cases with renal tumours | Quantitative and qualitative assessments of patient-specific 3D printed models on medical trainees’ understanding of renal tumours | CT | N/A | Stereolithography (SLA) | • 3D printed models improved medical trainees’ ratings (accuracy) with reduced variability when compared to CT scans with strong correlation using 3D model vs using the CT scans alone (ICC: 0.719 vs. 0.284) |
| Translucent Resin | • 3D printed models improved medical trainees’ understanding of renal malignancy compared to CT (P<0.01) | |||||
| Komai et al. 2016 (16) | 10 cases with renal tumours | 4D navigation in minimally invasive surgical procedures through 3D printed models | CT | ZedView (LEXI Co, Ltd, Tokyo, Japan)/Geomagic (Freeform, Geomagic, Rock Hill, SC) | Connex 500 (Stratasys Ltd., MN,USA) | • 3D printed models assist surgeons to perform minimally invasive procedure of partial nephrectomy by significantly shortening intraoperative ultrasound duration (mean 3.3 vs. 6.3 min with and without using 3D model, P=0.021) |
| Acrylic resin | • 3D printed models improve patient’s understanding of their disease status when compared to viewing CT images alone | |||||
| USD$450–680 | ||||||
| 3D printing: 4–9 h | ||||||
| Model completion: 3–9 days | ||||||
| Kusaka et al. 2015 (17) | Case report with 1 case for donor graft kidney model and 1 case for donor graft kidney and recipient pelvic cavity | Clinical application of 3D kidney graft models and pelvic cavity replicas for pre-surgical simulation in living kidney transplantation | CT | OsiriX (Pixmeo, Geneva, Switzerland) | Connex 500 (Stratasys Ltd., MN, USA) | • 3D printed life-size models improve understanding of relationship among anatomical structures and may reduce intraoperative complications |
| Magics (Materialise, Leuven, Belgium) | VeroClear and TangoPlus for printing renal parenchyma, TangoPlus/VeroMagenta blend, TangoPlus/VeroCyan blend, TangoPlus/VeroMagenta/VeroCyan blend for renal artery, renal artery vein and urinary tract structures, respectively | • 3D printed models show beneficial roles in kidney transplantation surgery | ||||
| Marconi et al. 2017 (30) | 15 cases scheduled for minimally invasive surgery with renal tumours in 2 cases | Objective assessment of 3D printed models in preoperative planning and surgical training of renal disease by 30 participants (10 medical students, 10 general surgeons and 10 radiologists) | CT | Paraview (http://www.paraview.org | USD$200–240 | • 3D printed models led to highest percentage of correct answers in identifying anatomical structures (53.9%±4.6) compared to 3D virtual reconstructions (53.4%±4.6) and 2D CT images (45.5%±4.6) |
| 20–30 h | • Participants spent significantly shorter time on evaluating 3D printed models (60.67±25.5 s) than on 2D CT images (127.04±35.91 s), and shorter than on 3D virtual reconstruction images (70.8±28.18 s) | |||||
| Porpiglia et al. 2018 (31) | 18 cases with 8 undergoing robot-assisted radical prostatectomy and 10 minimally invasive partial nephrectomy | Usefulness of 3D printed models in pre-surgical planning, training and education | CT for renal tumours MRI for prostate cancer. |
M3DISC | Selective laser sintering | • Overall median usefulness of 3D printed models and benefits compared to 3D virtual models as assessed by urologists and patients was ≥8 out of 10 |
| Powder | • Accuracy of 3D printed models in replicating anatomical details was 10 out of 10 | |||||
| • Improving understanding of surgical procedure and surgical planning was 8 out of 10 | ||||||
| • Patient’s perception about usefulness of 3D printed models was 10 out of 10 | ||||||
| von Rundstedt et al. 2017 (32) | 10 cases with renal tumours | Development of a novel protocol using 3D printed models for pre-surgical planning and simulation of robot-assisted laparoscopic partial nephrectomy | CT or MRI | 3D Slicer (https://www.slicer.org) | Lazarus 3D (Houston, TX, USA) | • No significance difference was found in total tumour volume between original 3D CT (38.88 mm3), resected pre-surgical model (38.50 mm3) and resected tumour specimen (41.79 mm3) (P=0.98) |
| Silicone rubber | • No significance difference was found in resection times between 3D printed models and actual surgery (6.61 vs. 7.93 min, P=0.162) | |||||
| • Patient-specific 3D printed models assist surgical training and decision-making in patients scheduled for partial nephrectomy | ||||||
| Liu et al. 2018 (33) | 2 cases of renal tumours | Comparison of 3D printed model accuracy between home-made 3D printer and commercial one | CT | Analyze 12.0 (AnalyzeDirect, Inc., Lexana, KS, USA) | Object 260 (Stratesys, EDEN 260 VS) vs. Home-made 3D printer | • Measurements on tumour diameters between commercial and home-made 3D printers were less than 1.0 mm |
| 1.5 h | TangoPlus vs. Polylactide | • Good correlation between original 3D CT images and 3D printed models in measurements of tumour diameters (differences <1.0 mm) | ||||
| 3.5 vs .4–5 h for each kidney | • Feasibility of producing 3D printed models with use of home-made 3D printer with similar accuracy but much lower cost than the commercial one | |||||
| USD$200 vs. USD$1 | ||||||
| Wake et al. 2017 (18) | 10 cases with renal tumours | Impact of 3D printed renal tumour models on surgical planning of renal cancer | MRI | Mimics 16.0 (Materialise, Belgium) | Connex 500 (Stratasys, MN, USA) | • Good correlation in tumour measurement between 2D images and 3D printed models with mean difference <1.5% (r=0.988, P<0.001) |
| 7 h per kidney model | VeroCyan and VeroMagenta | • Use of 3D printed models led to a change in planned approach in all cases with greatest impact noted on transperitoneal or retroperitoneal approach and clamping, with changed approaches in 30–50% cases | ||||
| USD$1,000 | ||||||
| 10 h to print each model | • 3D printed models improved understanding of anatomy, decisions on surgical approach and surgeons’ confidence in procedure planning | |||||
| Zhang et al. 2016 (34) | 10 cases with renal tumours | Impact of 3D printed models on surgical planning, training and patient’s understanding of renal tumour surgery | CT | Medical Imaging TookKit (MITK) and 3DMed | LaserCore 5300 (Longyuan Rapid Prototyping Ltd., Beijing, China) | • Overall usefulness of 3D printed models, assistance in surgical planning and training, and realism were rated with mean scores: 7.8, 8.0 and 6.0–7.8 out of 10, respectively |
| Thermoplastic plastics | • Patient’s overall satisfaction of the 3D models was ≥9.0 out of 10 | |||||
| USD$150 | • Tumour diameter was measured on original CT images, 3D printed models and actual specimens: 39.3±11.4, 34.5±13.0, and 37.9±11.0 mm, with size deviation of 3.4±1.3 mm between 3D model and specimen | |||||
| 3–4 days |
CT, computed tomography; ICC, intraclass correlation coefficient; MRI, magnetic resonance imaging; N/A, not available.