3D-Printed Simulation Device for Orbital Surgery

作者：Lichtenstein Juergen Thomas^*; Zeller Alexander Nicolai; Lemound Juliana; Lichtenstein Thorsten Enno; Rana Majeed; Gellrich Nils Claudius; Wagner Maximilian Eberhard

来源：Journal of Surgical Education, 2017, 74(1): 2-8.

DOI：10.1016/j.jsurg.2016.07.005

• orbit
• simulation training
• computer-aided design
• three-dimensional printing
• computer-assisted surgery

OBJECTIVES: Orbital surgery is a challenging procedure because of its complex anatomy. Training could especially benefit from dedicated study models. The currently available devices lack sufficient anatomical representation and realistic soft tissue properties. Hence, we developed a 3D-printed simulation device for orbital surgery with tactual (haptic) correct simulation of all relevant anatomical structures.
DESIGN, SETTING, AND PARTICIPANTS: Based on computed tomography scans collected from patients treated in a third referral center, the hard and soft tissue were segmented and virtually processed to generate a 3D-model of the orbit. Hard tissue was then physically realized by 3D printing. The soft tissue was manufactured by a composite silicone model of the nucleus and the surrounding tissue over a negative mold model also generated by 3D-printing. The final model was evaluated by a group of 5 trainees in oral and maxillofacial surgery (1) and a group of 5 consultants (2). All participants were asked to reconstruct an isolated orbital floor defect with a titanium implant. A stereotactic navigation system was available to all participants. Their experience was evaluated for haptic realism, correct representation of surgical approach, general handling of model, insertion of implant into the orbit, placement and fixation of implant, and usability of navigated control. The items were evaluated via nonparametric statistics (1 [poor]-5 [good]).
RESULTS: Group 1 gave an average mark of 4.0 (+/- 0.9) versus 4.6 (+/- 0.6) by group 2. The haptics were rated as 3.6 (+/- 1.1) [1] and 4.2 (+/- 0.8) [2]. The surgical approach was graded 3.7 (+/- 1.2) [1] and 4.0 (+/- 1.0) [2]. Handling of the models was rated 3.5 (+/- 1.1) [1] and 4 (+/- 0.7) [2]. The insertion of the implants was marked as 3.7 (+/- 0.8) [1] and 4.2 (+/- 0.8) [2]. Fixation of the implants was also perceived to be,realistic with 3.6 (+/- 0.9) [1] and 4.2 (+/- 0.45) [2]. Lastly, surgical navigation was rated 3.8 (+/- 0.8) [1] and 4.6 (+/- 0.56) [2].
CONCLUSION: In this project, all relevant hard and soft tissue characteristics of orbital anatomy could be realized. Moreover, it was possible to demonstrate that the entire workflow of an orbital procedure may be simulated. Hence, using this model training expenses may be reduced and patient security could be enhanced.

• 出版日期2017-2