3D Printing Technology in Open Living Donor Nephrectomy
The shortage of organ sources is a critical issue in the field of transplantation, making living donor kidneys an essential alternative to deceased donor kidneys. Open donor nephrectomy is one of the most challenging procedures in kidney transplantation, primarily due to concerns about donor safety and the psychological stress on surgeons. The core objectives are to minimize surgical complications for the donor, maximize the success rate, and manage the high expectations from the recipient. The introduction of 3D printing technology has revolutionized this process by providing a more intuitive and accurate representation of the surgical site and surrounding tissue structures before the operation begins. This technology allows surgeons to better understand the anatomical structure of the surgical site, create a detailed operational plan, and even perform a simulated operation based on a patient-specific 3D-printed model.
This study was conducted at The First Affiliated Hospital of Xi’an Jiaotong University, China, and involved 120 living kidney donors and their corresponding transplant recipients who underwent living kidney transplantation between January 2016 and December 2019. The participants were randomly divided into two groups: the 3D printing group and the traditional operation group. The 3D printing group underwent a specific protocol that included obtaining raw data images from donor kidney computed tomography angiography (CTA) and CT urography (CTU). These images were processed using Mimics software 21.0 to segment cross-section images and extract printed tissue using threshold and regional growth methods. The data were then transmitted to 3D printers in Laplace smoothing and StL format. The 3D printer used photoreceptor resin to create the models, which were allowed to dry and stabilize for 4 to 6 hours. Based on these models, an operation plan was created, and a simulated operation was performed.
In the traditional operation group, routine pre-operative preparation was conducted, including CTA, CTU, and B ultrasound. During CTA examination, 42 patients were identified with accessory renal arteries, including five with bilateral renal accessory arteries, 18 with right accessory renal arteries, and 19 with left accessory renal arteries. Vascular variation was found in 22 cases (37%) of the 3D printing group before surgery, compared to 11 cases (18%) in the traditional operation group. The diagnostic rate of vascular variation was significantly higher in the 3D printing group (x2 = 5.06, P < 0.05). Intraoperatively, 24 cases of vascular variation that needed to be treated were found in the 3D printing group, with a consistent rate of 92% (22/24). In contrast, 20 cases were found in the traditional operation group, with a diagnostic consistency rate of 55% (11/20), a statistically significant difference (x2 = 7.82, P < 0.05).
The total operation time in the 3D printing group was significantly shorter (88.8 ± 8.2 min) compared to the traditional operation group (100.4 ± 11.4 min). The amount of intra-operative bleeding was also lower in the 3D printing group (79.9 ± 18.7 mL) than in the traditional operation group (92.1 ± 19.4 mL; P < 0.05). On the first day after the operation, serum creatinine (sCr) levels in the 3D printing group were significantly lower (69.4 ± 14.4 mmol/L) compared to the traditional operation group (86.8 ± 12.9 mmol/L; P = 0.001). The recovery time of function for the transplanted kidney was faster in the 3D printing group (3.7 ± 2.7 days) than in the traditional operation group (5.1 ± 1.6 days; P = 0.040). Additionally, sCr levels in donor patients decreased more rapidly on the first day after operation in the 3D printing group (430.2 ± 134.1 mmol/L) compared to the traditional operation group (565.7 ± 193.7 mmol/L; P = 0.001).
The study demonstrated that the 3D printing group had several advantages, including shorter operation time, reduced intra-operative bleeding, higher diagnostic rate of vascular variation, lower sCr levels on the first day after operation, and faster recovery time of transplanted kidney function. The 3D-printed models helped surgeons better understand the anatomical structures of the operation site, create a more detailed operation plan, and perform a simulated operation on the model. This approach allowed for quicker identification of the operation site, avoidance of unnecessary steps, and overall reduction of surgical risks, thereby improving the success rate of the operation. Specifically, for vascular variation, the 3D printing models provided detailed anatomical information about the initiation and shape of the vessels, which was crucial for preserving renal function post-transplantation. Additionally, these models improved doctor-patient communication by helping patients better understand their conditions and the planned surgical procedures.
The study also highlighted that the lower sCr levels on the first day after operation in the 3D printing group were mainly related to less intra-operative bleeding, shorter operation time, and reduced anesthesia time. However, there were no statistically significant differences between the two groups in terms of renal warm ischemia time, the incidence of perioperative complications, and the length of hospital stay. The shorter recovery time of the transplanted kidney function in the 3D printing group was attributed to the reduction of mechanical injury during the surgical procedure, maximum protection of the accessory renal artery, and effective retention of renal units after transplantation.
3D printing technology represents a significant breakthrough in the field of kidney transplantation, offering new possibilities for the diagnosis and treatment of renal diseases. This study confirmed that using 3D-printed models can optimize living donor nephrectomy procedures by reducing operation time, minimizing intra-operative bleeding, lowering acute sCr changes, and speeding up the recovery time of transplanted kidney function. These improvements protect the kidney, reduce the difficulty of the operation, and enhance doctor-patient communication, ultimately leading to better patient outcomes. As 3D materials and technologies continue to innovate, the application of this technology in areas such as transplanted kidney ureteral obstruction, renal tumor, stone, and organ printing holds great promise.
doi.org/10.1097/CM9.0000000000001996
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