Use of Three-Dimensional-Printed Liver Models for Clinical Education, Intraoperative Guidance and Surgical Planning: A Systematic Review

Hepatobiliary surgery is a technically complex subspecialty within general surgery, which requires a comprehensive understanding of complex liver and liver tumour anatomy. The current body of literature highlights the use of three-dimensional-printed liver models (3DPLMs) reconstructed from medical imaging datasets may improve clinician comprehension of patient-specific liver anatomy thus creating a useful tool for hepatobiliary surgical planning and clinician training. The purpose of this systematic review was to examine the clinical utility and feasibility of 3DPLMs in hepatobiliary surgical planning and clinical education and investigate whether these applications influence patient outcomes. Studies were retrieved from three electronic databases (ProQuest, PubMed and Scopus) according to predetermined eligibility criteria. In total, 25 eligible articles were identified, including 18 original research articles and seven case reports. An inductive content analysis approach suitable for heterogeneous bodies of literature was used to synthesise key concepts in this review. There are significant case report and descriptive evidence to support the use of 3DPLMs in clinical education, preoperative planning and intraoperative guidance of patient liver and tumour anatomy to improve hepatobiliary surgical decision making. The studies presented display a large variance in cost and times necessary for the production of 3DPLMs, as studies did not include the software, equipment and full expense of materials used. Additionally, studies concentrated on different aspects of the 3DPLMs production process making them not comparable. This review demonstrates the potential value of 3DPLMs in clinical education, preoperative planning and intraoperative guidance in hepatobiliary anatomy and surgery. Future studies, in particular, randomised controlled trials and experimental research are required to investigate the relationship between 3DPLMs and clinical education and surgical planning outcomes.