Value of 3D Printing for Comprehension of Liver Surgical Anatomy

Study Overview
=================
Brief Summary
-----------------
To our knowledge, it has not been analyze whether 3D printed liver model would improve the perception of a given liver tumor or the precision of operation planning in liver surgery. We design this prospective controlled trial to test whether the 3D-printed patient specific liver model could be more informative than standard MDCT (multi-row detector computed tomography ) and 3D visualization system in predicting the surgical anatomy of liver.

Detailed Description
-----------------
The primary objective was to investigate whether 3D printing can improve localization of hepatic pathology. The secondary objective was to investigate whether 3D printing can improve the precision of surgical proposal. The dataset of patients were prepared and stratified into MDCT, 3D visualization system and 3D printed liver model groups. The process started from MDCT scan image acquisition and moved through image segmentation and 3D rendering to end up with 3D printing. Surgical residents were assigned to three different groups to study different modes of patients' data. Residents were ask to state the liver segment in which the tumor resides and make a minimal resection proposal, including the tumor, the safety margin (1cm) and the dependent liver tissue. Residents were recommended to proceed in a classic way by resecting the whole liver segment. The time spent by each resident was also recorded in order to assess the quickness of comprehension and information transfer of the three different modes of presentation.

Official Title
-----------------
Value of 3D Printing for Comprehension of Liver Surgical Anatomy

Conditions
-----------------
Liver Cancer

Intervention / Treatment
-----------------
* Other: surgical residents' comprehension of the hepatic anatomy


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Surgical residents Must had experiences with MDCT and 3D visualization system Exclusion Criteria: Non surgical residents No experiences with MDCT or 3D visualization system
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| MDCT group<br>The MDCT images of seven hepatic tumors were loaded on software to uniform study conditions, allowing both axial and coronal scans visualization. | Other: surgical residents' comprehension of the hepatic anatomy<br>* Surgical residents were assigned to three different groups to evaluate different modes of patients' data. Residents were ask to state the liver segment in which the tumor resided and make a minimal resection proposal, including the tumor, the safety margin (1cm) and the dependent liver tissue. Residents were recommended to proceed in a classic way by resecting the whole liver segment. The time spent by each resident was also recorded in order to assess the quickness of comprehension and information transfer of the three different modes of presentation.<br>|
| 3D visualization system group<br>The 3D virtual reconstructions of seven hepatic tumors were loaded on the visualization software which enables the rotation of the virtual model. | Other: surgical residents' comprehension of the hepatic anatomy<br>* Surgical residents were assigned to three different groups to evaluate different modes of patients' data. Residents were ask to state the liver segment in which the tumor resided and make a minimal resection proposal, including the tumor, the safety margin (1cm) and the dependent liver tissue. Residents were recommended to proceed in a classic way by resecting the whole liver segment. The time spent by each resident was also recorded in order to assess the quickness of comprehension and information transfer of the three different modes of presentation.<br>|
| 3D printing group<br>3D-printed models of seven hepatic tumors were created based on MDCT images, participants were allowed to freely handle them. | Other: surgical residents' comprehension of the hepatic anatomy<br>* Surgical residents were assigned to three different groups to evaluate different modes of patients' data. Residents were ask to state the liver segment in which the tumor resided and make a minimal resection proposal, including the tumor, the safety margin (1cm) and the dependent liver tissue. Residents were recommended to proceed in a classic way by resecting the whole liver segment. The time spent by each resident was also recorded in order to assess the quickness of comprehension and information transfer of the three different modes of presentation.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcomes was the precise allocation of hepatic disease | For tumor allocation to the liver segments, 8 points were awarded if all segments were correctly identified in which the tumors resided. If the tumors was located in more than one segment, the 8 maximal achievable points were divided between these segments. Erroneously identified segments were awarded 0 point. Alternatively, the primary outcomes were also simply judged as right or wrong according to the final surgical results. | The primary outcome was assessed within 1 week after the collection of each participants' response. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Resection proposal of liver pathology | he resection proposals on the liver were compared with surgical results that had been evaluated by surgeons and judged by the formula mentioned earlier. | The secondary outcome was assessed within 1 week after the collection of each participants' response. | 
| Time spent to judge tumor location | The time spend to assess tumor location by each resident was documented as seconds | The secondary outcome was assessed within 1 week after the collection of each participants' response. |