2020    Luigi Marano , Alessandro Ricci, Vinno Savelli, Luigi Verre, Luca Di Renzo, Elia Biccari      

Abstract

Background: Three-dimensional (3D) printing may represent a useful tool to provide, in surgery, a good

representation of surgical scenario before surgery, particularly in complex cases. Recently, such a technology has

been utilized to plan operative interventions in spinal, neuronal, and cardiac surgeries, but few data are available in

the literature about their role in the upper gastrointestinal surgery. The feasibility of this technology has been

described in a single case of gastroesophageal reflux disease with complex anatomy due to a markedly tortuous

descending aorta.

Methods: A 65-year-old Caucasian woman was referred to our Department complaining heartburn and pyrosis. A

chest computed tomography evidenced a tortuous thoracic aorta and consequent compression of the esophagus

between the vessel and left atrium. A “dysphagia aortica” has been diagnosed. Thus, surgical treatment of anti-reflux

surgery with separation of the distal esophagus from the aorta was planned. To define the strict relationship between

the esophagus and the mediastinal organs, a life-size 3D printed model of the esophagus including the proximal

stomach, the thoracic aorta and diaphragmatic crus, based on the patient’s CT scan, was manufactured.

Results: The robotic procedure was performed with the da Vinci Surgical System and lasted 175 min. The surgeons

had navigational guidance during the procedure since they could consult the 3D electronically superimposed

processed images, in a “picture-in-picture” mode, over the surgical field displayed on the monitor as well as on the

robotic headset. There was no injury to the surrounding organs and, most importantly, the patient had an

uncomplicated postoperative course.

Conclusions: The present clinical report highlights the feasibility, utility and clinical effects of 3D printing technology

for preoperative planning and intraoperative guidance in surgery, including the esophagogastric field. However, the

lack of published data requires more evidence to assess the effectiveness and safety of this novel surgical-applied

printing technology.

Keywords: 3D printing, Anatomy, Technology, Model, Robotic surgery, Esophageal surgery