Surgery (Austin & Northern Health) - Research Publications
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ItemA systematic review of three-dimensional printed template-assisted physician-modified stent grafts for fenestrated endovascular aneurysm repair(MOSBY-ELSEVIER, 2021-07)OBJECTIVE: Fenestrated endovascular aneurysm repair has yet to gain widespread adoption owing to the technical complexity and increased risk of complications. Three-dimensional (3D) printed templates to guide fenestrated physician-modified stent grafts (PMSGs) are a novel technique that may have the potential to increase the accuracy of fenestration alignment, and to disrupt both the cost and timing of the current commercial fenestrated endograft supply chain. We have conducted a critical appraisal of the emerging literature to assess this. METHODS: A systematic literature search was performed using PubMed and OVID Medline as guided by the PRISMA statement on April 30, 2020. We used "3D printing" and "physician modified" or "surgeon modified" and all related search terms. We identified 50 articles which met our search criteria. None articles were included as being of direct relevance to 3D-printed template-assisted PMSGs for fenestrated endovascular aneurysm repair. Abstracts were screened individually by each investigator to ensure relevance. RESULTS: Nine relevant articles were identified for critical analysis. These included one technical report, five case reports or series, two prospective trials, and one letter to the editor. CONCLUSIONS: These 3D-printed templates are a promising new avenue to assist with the placement of fenestrations in PMSGs, particularly in urgent or emergent cases where custom fenestrated endografts are unavailable, with larger scale studies warranted. Further work to validate the key stages of the template workflow are required, as well as further investigation into the most suitable manufacturing and distribution methods before the mainstream implementation of this novel technique.
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ItemAccessing 3D Printed Vascular Phantoms for Procedural Simulation(FRONTIERS MEDIA SA, 2021-01-27)Introduction: 3D printed patient-specific vascular phantoms provide superior anatomical insights for simulating complex endovascular procedures. Currently, lack of exposure to the technology poses a barrier for adoption. We offer an accessible, low-cost guide to producing vascular anatomical models using routine CT angiography, open source software packages and a variety of 3D printing technologies. Methods: Although applicable to all vascular territories, we illustrate our methodology using Abdominal Aortic Aneurysms (AAAs) due to the strong interest in this area. CT aortograms acquired as part of routine care were converted to representative patient-specific 3D models, and then printed using a variety of 3D printing technologies to assess their material suitability as aortic phantoms. Depending on the technology, phantoms cost $20-$1,000 and were produced in 12-48 h. This technique was used to generate hollow 3D printed thoracoabdominal aortas visible under fluoroscopy. Results: 3D printed AAA phantoms were a valuable addition to standard CT angiogram reconstructions in the simulation of complex cases, such as short or very angulated necks, or for positioning fenestrations in juxtarenal aneurysms. Hollow flexible models were particularly useful for device selection and in planning of fenestrated EVAR. In addition, these models have demonstrated utility other settings, such as patient education and engagement, and trainee and anatomical education. Further study is required to establish a material with optimal cost, haptic and fluoroscopic fidelity. Conclusion: We share our experiences and methodology for developing inexpensive 3D printed vascular phantoms which despite material limitations, successfully mimic the procedural challenges encountered during live endovascular surgery. As the technology continues to improve, 3D printed vascular phantoms have the potential to disrupt how endovascular procedures are planned and taught.
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ItemNo Preview AvailableClinical trials in urological oncology: COVID-19 and the potential need for a new perspective(SPRINGER, 2021-09)The COVID-19 pandemic has led to the suspension, termination or alteration of thousands of clinical trials as the health emergency escalated globally. Whilst the rapid suspension of certain clinical trials was necessary to ensure the safety of high-risk or vulnerable trial participants as well as healthcare workers, the long-term ramifications that this delay will have on the field of urologic oncology is unknown. The COVID-19 pandemic has highlighted the need to plan for and implement new strategies to advance our understanding of unmet areas of need in urologic oncology. The COVID-19 pandemic has led to the suspension, termination or alteration of thousands of clinical trials as the health emergency escalated globally. Whilst the rapid suspension of certain clinical trials was necessary to ensure the safety of high-risk or vulnerable trial participants as well as healthcare workers, the long-term ramifications that this delay will have on the field of urologic oncology is unknown. The COVID-19 pandemic has highlighted the need to plan for and implement new strategies to advance our understanding of unmet areas of need in urologic oncology.