Development of Hepatic Vasculature Models for Preoperative Planning; Investigating the Underlying Reasons for the Adoption of 3D Printed Models into Medical Education

Hepatic arterial embolization is a procedure widely used in the treatment of liver tumors that involves the navigation of a catheter through the minute vasculature. However, this procedure presents challenges due to individual variations in the complex vascular anatomy and difficulty visualizing the 3D branching of the vessels through 2D X-ray imaging during the surgery. Thus, clinicians have recognized the need for enhanced training and preparation methods to address these concerns. Indeed, over 1⁄4 of surgical residents polled indicated that they lack the confidence to perform on patients independently from overseeing physicians.1 It is essential for practicing surgeons and residents to gain experience and confidence in utilizing surgical tools and imaging methods. To address these concerns, physicians and researchers have turned to the creation of 3D-printed anatomical models that can be used to teach and practice surgical strategies. This method allows for patient-specific and rapidly-prototyped models. The challenge that remains is the recreation of the small, hollow, and tortuous geometry of the vessels. Here, we present the development and application of three manufacturing methods of hepatic vasculature models for use as preoperative planning tools: hollow 3D printing, casting of a solid model in silicone, and 3D printing of a negative-space model. Utilizing 3D printing in combination with additional manufacturing methods, we were able to address some limitations of 3D printing alone. From this work, we determined that the 3D printed negative space model was the most ideal method of those tested for the creation of a preoperative planning tool for hepatic arterial embolization.