Do Three-dimensional Visualization and Three-dimensional Printing Improve Hepatic Segment Anatomy Teaching? A Randomized Controlled Study

doi:10.1016/j.jsurg.2015.10.002

Journal of Surgical Education

Volume 73, Issue 2, March–April 2016, Pages 264-269

https://doi.org/10.1016/j.jsurg.2015.10.002 Get rights and content

Introduction

Hepatic segment anatomy is difficult for medical students to learn. Three-dimensional visualization (3DV) is a useful tool in anatomy teaching, but current models do not capture haptic qualities. However, three-dimensional printing (3DP) can produce highly accurate complex physical models. Therefore, in this study we aimed to develop a novel 3DP hepatic segment model and compare the teaching effectiveness of a 3DV model, a 3DP model, and a traditional anatomical atlas.

Materials and Methods

A healthy candidate (female, 50-years old) was recruited and scanned with computed tomography. After three-dimensional (3D) reconstruction, the computed 3D images of the hepatic structures were obtained. The parenchyma model was divided into 8 hepatic segments to produce the 3DV hepatic segment model. The computed 3DP model was designed by removing the surrounding parenchyma and leaving the segmental partitions. Then, 6 experts evaluated the 3DV and 3DP models using a 5-point Likert scale. A randomized controlled trial was conducted to evaluate the educational effectiveness of these models compared with that of the traditional anatomical atlas.

Results

The 3DP model successfully displayed the hepatic segment structures with partitions. All experts agreed or strongly agreed that the 3D models provided good realism for anatomical instruction, with no significant differences between the 3DV and 3DP models in each index (p > 0.05). Additionally, the teaching effects show that the 3DV and 3DP models were significantly better than traditional anatomical atlas in the first and second examinations (p < 0.05). Between the first and second examinations, only the traditional method group had significant declines (p < 0.05).

Conclusion

A novel 3DP hepatic segment model was successfully developed. Both the 3DV and 3DP models could improve anatomy teaching significantly.

Introduction

Hepatic segmental anatomy, first proposed by Claude Couinaud in 1956, is the basis of modern functional and surgical liver anatomy.1, 2, 3 Therefore, good understanding of anatomical structures of hepatic segment is of great importance for medical students. However, the complexity of the hepatic ducts’ distribution makes this subject difficult to master.⁴

Many tools, such as anatomical atlases and corrosion casts, have been used to teach this anatomy. Among these, three-dimensional visualization (3DV) of computer hepatic segment models is a valuable aide because it vividly details the internal hepatic segments and their structures.5, 6 Crossingham et al.⁷ used interactive three-dimensional (3D) liver models to help teach trainees the liver’s complex spatial anatomy. Jurgaitis et al.⁸ further confirmed that computer-generated 3DVs of the liver images could teach clinical hepatic anatomy to medical students more effectively than two-dimensional atlases. However, 3DVs lack many of the haptic qualities of a physical specimen; therefore, they cannot completely replace physical teaching aids.

A feasible way to produce physical hepatic segment models is three-dimensional printing (3DP), or rapid prototyping production, because it can transfer the complex computer models to physical ones through additive production. This technology has been developed over decades and used in the medical field for years.9, 10, 11, 12 For example, physical models of the lung with arteries, veins, and tracheal bronchus, and pulmonary segments have been printed.¹³ More recently, physical liver models with complex networks of vascular and biliary structures have been printed for preoperative planning in donor liver transplantation.¹⁴ But so far, no hepatic segment models have been printed for anatomy teaching, nor have the effects of using such models for education been evaluated.

Therefore, in this study, we aimed to develop a novel 3DP hepatic segment model and evaluate the teaching effectiveness of 3DV and 3DP models compared with that of traditional instruction with anatomical atlases.

Section snippets

3D Reconstructions of Hepatic Structures

A healthy candidate (female, 50-years old) was recruited. After a vascular contrast agent was injected, enhanced computed tomography (CT) scanning was performed with a Brilliance CT 64-channel scanner (Philips, Eindhoven, Netherlands) and compiled into sectional images. Then, 2 experienced radiologists examined the liver dataset to exclude liver disease. The upper abdomen data included 397 sectional images in 0.5-mm intervals with a pixel size of 0.684 mm.

The CT dataset was processed and edited

3DP Hepatic Segment Models

The 3DP model was successfully developed to distinguish the portal and hepatic veins with specific colors and display the hepatic segment structures with partitions clearly. The smallest branches of the model have diameters of approximately 1.4 mm. Hepatic segments and parenchyma morphology could be clearly displayed by the frame structures made of the segmental partitions and the bottom surface of the parenchyma (Fig. 3).

Experts’ Evaluation of the Hepatic Segment Models

All experts agreed or strongly agreed that the models provided good

Discussion

Learning hepatic segment anatomy is difficult and frustrating for medical students and young residents8, 19, 20, 21, 22 because the liver is an extremely complex organ with spatially entwined, branching ducts. Learners often need to refer to anatomy textbooks and two-dimensional atlases to undergo the difficult and inefficient process of creating a mental image of the liver’s stereo structures. A more useful teaching aid could facilitate more efficient and effective learning.

Corrosion casts are

Conclusion

A novel 3DP model that can display the structures of hepatic segments was successfully developed. The 3DV and 3DP models had the same effect on the effectiveness of anatomy education compared with the traditional method using anatomy atlases. However, our study has 2 limitations. Firstly, as the images came from a healthy candidate, the vascular contrast agent could not reach the finer branches, and therefore the diameters in the 3DV and 3DP models were no smaller than 1.4 mm. With a cadaveric

Acknowledgment

61190122 and 61190123 from National Natural Science Foundation of China, China.

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¹: Contributed equally to this work.

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Original ReportsDo Three-dimensional Visualization and Three-dimensional Printing Improve Hepatic Segment Anatomy Teaching? A Randomized Controlled Study

Introduction

Materials and Methods

Results

Conclusion

Introduction

Section snippets

3D Reconstructions of Hepatic Structures

3DP Hepatic Segment Models

Experts’ Evaluation of the Hepatic Segment Models

Discussion

Conclusion

Acknowledgment

Surgery

HPB

J Surg Res

J Am Coll Surgeons

The use of segmental anatomy for an operative classification of liver injuries

Ann Surg

Techniques of hepatic resection

J Gastrointest Oncol

Milestones in the evolution of hepatic surgery

Rambam Maimonides Med J

Three-dimensional visualisation improves understanding of surgical liver anatomy

Med Educ

Virtual reality applied to hepatic surgery simulation: the next revolution

Ann Surg

The comparison of 2-dimensional with 3-dimensional hepatic visualization in the clinical hepatic anatomy education

Medicina

Construction and accuracy assessment of patient-specific biocompatible drill template for cervical anterior transpedicular screw (ATPS) insertion: an in vitro study

PLoS One

A novel patient-specific navigational template for cervical pedicle screw placement

Spine

Use of 3D printing for auricular template molds in first stage microtia

Plast Reconstr Surg

3D printing of an aortic aneurysm to facilitate decision making and device selection for endovascular aneurysm repair in complex neck anatomy

J Endovasc Ther

Maximizing modern distribution of complex anatomical spatial information: 3D reconstruction and rapid prototype production of anatomical corrosion casts of human specimens

Anat Sci Educ

Original Reports
Do Three-dimensional Visualization and Three-dimensional Printing Improve Hepatic Segment Anatomy Teaching? A Randomized Controlled Study