3D Printing in Gynecologic Surgery – an Innovative Tool for Surgical Planning

Study Objective To evaluate the impact of 3-dimensional (3D) digital and printed models on minimally invasive gynecologic surgeons’ operative plan, outcomes, and experience. Design Prospective, cross-sectional, repeated measures design. Setting Pre-, intra-, and post-operative minimally invasive gynecologic surgery. Patients or Participants Minimally Invasive Gynecology (MIG) surgeons (n=6) at The Ottawa Hospital (TOH) and their respective surgical cases (n=50). Interventions Using our team's 3D printing protocol, patient-specific 3D digital and printed models are produced from cross-sectional MR images. Surgeons complete a pre-operative questionnaire before and after viewing the models. They are given the opportunity to consult the models intra-operatively, and, finally, complete a post-operative questionnaire. Chi-square test of independences, Mann-Whitney U, and dependent T-tests will be used to evaluate significant differences between variables related to surgical plan before and after viewing models. Descriptive statistics will be used to evaluate surgeon experience. Measurements and Main Results Two cases have been completed to date. The first was a proof of concept to establish our 3D printing and study protocols. In this case, a 3D model of a multifibroid uterus was printed for myomectomy planning in a 42-year-old G0P0 with bulk symptoms. In the second case, a 3D model was printed to plan for myomectomy in a 45-year-old G5P1 with future fertility goals. Viewing the 3D digital and printed model affected the surgeons’: planned hemostatic techniques, perceived surgical complexity, allocated operative time, anticipated risk of complications, confidence in surgical plan, and positively impacted their surgical experience. Conclusion Patient-specific 3D models increase understanding of complex anatomy in gynecologic surgery, optimizing pre-operative planning, intra-operative performance, surgeon experience, and patient outcomes.