The experience of using additive technologies for three-dimensional reconstruction of the lungs in the clinical practice of a tuberculosis dispensary

The aim was to study the volume of blood loss and the duration of a surgical session in patients with destructive pulmonary tuberculosis using threedimensional anatomical models of the lungs. 
Methods. The study was conducted in 2020 – 2021 in the State Budgetary Healthcare Institution of the Nizhniy Novgorod region “Nizhny Novgorod Regional Clinical Tuberculosis Dispensary” as part of an internal grant from the Federal State Budgetary Educational Institution of Higher Education “Privolzhsky Research Medical University” of the Ministry of Health of the Russian Federation. The prospective clinical study included 80 patients. All patients were divided into two groups. The main group included 40 patients. Preoperative lung reconstruction was performed for these patients. Thoracic surgeons used the three-dimensional anatomical models of the lungs to study the syntopy of healthy and diseased tissue (visual assessment) and prepare for the surgical session (cutting the model with a scalpel). Threedimensional preoperative lung reconstruction was not performed for the other 40 patients in the control group. In this group, the thoracic surgeons did not use 3D anatomical models of the lungs. Comparison of the results in the control and the main group was carried out using the Mann – Whitney U-test and Spearman and Kendall correlation tests. The obtained data are described with absolute and relative values, boxplots reflecting median (Me) and interquartile interval (IQI), scatter plots with trend lines, and probability density plots. The level of statistical significance of differences for testing the hypotheses was chosen at p < 0.05. 
Results. It was shown that the volume of blood loss (U = 590; p = 0.042) and the duration of surgery (U = 587; p = 0.041) in patients of the main group are smaller than in patients in the control group. A moderate correlation was established between the volume of blood loss and the duration of the surgical session (ρ = 0.54; p < 0.001) in the main group using the Spearman’s test. Kendall’s test also showed a positive correlation (τ = 0.42; p < 0.001). 
Conclusion. The established differences between the main group and control group in the volume of blood loss and the duration of surgery due to the inclusion of polymer models of the lungs in preoperative preparation of thoracic surgeons confirm our hypothesis about the effect of additive technologies on the above parameters and indicate the significance of the applied reconstruction method.

1. Nechaeva O.B. [The state and prospects of TB control service in Russia during the COVID-19 pandemic]. Tuberkulez i bolezni legkikh. 2020; 98 (12): 7–19. DOI: 10.21292/2075-1230-2020-98-12-7-19 (in Russian).

2. Nechaeva O.B. [TB situation in Russia]. Tuberkulez i bolezni legkikh. 2018; 96 (8): 15–24. DOI: 10.21292/2075-1230-2018-96-8-15-24 (in Russian).

3. Nechaeva O.B. [Tuberculosis in children in Russia]. Tuberkulez i bolezni legkikh. 2020; 98 (11): 12–20. DOI: 10.21292/2075-1230-2020-98-11-12-20 (in Russian).

4. Rogozhkin P.V., Borodulina E.A. [The Postponed treatment outcomes in pulmonary tuberculosis patients after radical pulmonary resection]. Tuberkulez i bolezni legkikh. 2018; 96 (3): 24–28. DOI: 10.21292/2075-1230-2018-96-3-24-28 (in Russian).

5. Giller D.B., Murgustov I.B., Martel' I.I. et al. [Repeated lung resections in patients with postoperative recurrent tuberculosis in the operated lung (literature review and own data)]. Khirurgiya. Zhurnal im. N.I. Pirogova. 2015; (8, Pt 2): 14–19. DOI: 10.17116/hirurgia20158214-19 (in Russian).

6. Krasnov V.A., Grishchenko N.G., Andrenko A.A. [Reoperations in patients with destructive forms of post-resection reactivation of pulmonary tuberculosis]. Tuberkulez i ekologiya. 1997; (1): 13–15 (in Russian).

7. Shchadenko S.V., Gorbacheva A.S., Arslanova A.R., Tolmachev I.V. [3D visualization for planning operations and performing surgery (CAS technologies)]. Byulleten' sibirskoy meditsiny. 2014; 13 (4): 165–171. Available at: https://cyberleninka.ru/article/n/3d-vizualizatsiya-dlya-planirovaniya-operatsiy-i-vypolneniya-hirurgicheskogo-vmeshatelstva-cas-tehnologii/viewer (in Russian).

8. Lazarenko V.A., Ivanov S.V., Ivanov I.S. et al. [Use of 3D printers in surgery (literature review)]. Kurskiy nauchno-prakticheskiy vestnik «Chelovek i ego zdorov'e». 2018; (4): 61–65. DOI: 10.21626/vestnik/2018-4/10 (in Russian).

9. Arapova I.A., Kucherova P.A. [3D printing in maxillofacial surgery]. Glavnyy vrach Yuga Rossii. 2017; 58 (5): 13–15. Available at: http://www.akvarel2002.ru/assets/files/journal/GV-58-preview.pdf (in Russian).

10. Prikhod'ko A.A., Vinogradov K.A., Vakhrushev S.G. [Measures for the development of medical additive technologies in the russian federation]. Meditsinskie tekhnologii. Otsenka i vybor. 2019; 36 (2): 10–15. Available at: https://cyberleninka.ru/article/n/mery-po-razvitiyu-meditsinskih-additivnyh-tehnologii-v-rossiyskoy-federatsii (in Russian).

11. Kerimbaev T.T., Aleynikov V.G., Smagul Zh. et al. [An overview of the use of 3D technologies in the surgical treatment of spinal tumors]. Neyrokhirurgiya i nevrologiya Kazakhstana. 2017; (4 (49): 61–65. Available at: https://cyberleninka.ru/article/n/obzor-primeneniya-3d-tehnologiy-v-hirurgicheskom-lechenii-opuholey-pozvonochnika (in Russian).

12. Bagaturiya G.O. [Prospects for the use of 3D-printing when planning surgery]. Meditsina: teoriya i praktika. 2016; (1): 26–35. Available at: http://ojs3.gpmu.org/index.php/med-theory-and-practice/article/view/249/262 (in Russian).

13. Mulberry G., White K.A., Vaidya M. et al. 3D printing and milling a real-time PCR device for infectious disease diagnostics. PLoS One. 2017; 12 (6): e0179133. DOI: 10.1371/journal.pone.0179133.

14. Öblom H., Zhang J., Pimparade M. et al. 3D-printed isoniazid tablets for the treatment and prevention of tuberculosis-personalized dosing and drug release. AAPS PharmSciTech. 2019; 20 (2): 52. DOI: 10.1208/s12249-018-1233-7.

15. Guibert N., Mhanna L., Didier A. et al. Integration of 3D printing and additive manufacturing in the interventional pulmonologists’s toolbox. Respir. Med. 2018; 134: 139–142. https://doi.org/10.1016/j.rmed.2017.11.019

16. Jamroz W., Szafraniec J., Kurek M., Jachowicz R. 3D printing in pharmaceutical and medical applications – recent achievements and challenges. Pharm. Res. 2018; 35 (9): 176. DOI: 10.1007/s11095-018-2454-x.

17. Rengier F., Mehndiratta A., von Tengg-Kobligk H. et al. 3D printing base on imaging data: review of medical applications. Int. J. Comput. Assist. Radiol. Surg. 2010; 5 (4): 335–341. DOI: 10.1007/s11548-010-0476-x.

18. Giannopoulos A.A., Mitsouras D., Yoo S.J. et al. Applications of 3D printing in cardiovascular diseases. Nat. Rev. Cardiol. 2016; 13 (12): 701–718. DOI: 10.1038/nrcardio.2016.170.

19. Ventola C.L. Medical applications for 3D printing: current and projected uses. P. T. 2014; 39 (10): 704–711.

20. Peterson G.I., Larsen M.B., Ganter M.A. et al. 3D-printed mechanochromic materials. ACS Appl. Mater. Interfaces. 2015; 7 (1): 577–583. DOI: 10.1021/am506745m.

21. Anciaux S.K., Geiger M., Bowser M.T. 3D printed micro free-flow electrophoresis device. Anal. Chem. 2016; 88 (15): 7675–7682. DOI: 10.1021/acs.analchem.6b01573.

22. Wang X., Ao Q., Tian X. et al. 3D bioprinting technologies for hard tissue and organ engineering. Materials (Basel). 2016; 9 (10): 802. DOI: 10.3390/ma9100802.

23. O’Brien E.K., Wayne D.B., Barsness K.A. et al. Use of 3D printing for medical education models in transplantation medicine: a critical review. Curr. Transpl. Rep. 2016; 3 (1): 109–119. DOI: 10.1007/s40472-016-0088-7.

24. Perica E., Sun Z. Patient-specific three-dimensional printing for pre-surgical planning in hepatocellular carcinoma treatment. Quant. Imaging Med. Surg. 2017; 7 (6): 668–677. DOI: 10.21037/qims.2017.11.02.

25. Aimar A., Palermo A., Innocenti B. The role of 3D printing in medical applications: a state of the art. J. Healthc. Eng. 2019; 2019: 5340616. DOI: 10.1155/2019/5340616.

26. Kwok J.K.S., Lau R.W.H., Zhao Z.R. et al. Multi-dimensional printing in thoracic surgery: current and future applications. J. Thorac. Dis. 2018; 10 (Suppl. 6): S756–763. DOI: 10.21037/jtd.2018.02.91.

27. Kim M.P., Ta A.H., Ellsworth W.A. 4th et al. Three dimensional model for surgical planning in resection of thoracic tumors. Int. J. Surg. Case Rep. 2015; 16: 127–129. DOI: 10.1016/j.ijscr.2015.09.037.

28. Nakada T., Akiba T., Inagaki T., Morikawa T. Thoracoscopic anatomical subsegmentectomy of the right S2b + S3 using a 3D printing model with rapid prototyping. Interact. Cardiovasc. Thorac. Surg. 2014; 19 (4): 696–698. DOI: 10.1093/icvts/ivu174.

29.