Preliminary application of three-dimensional printing in congenital uterine anomalies from three-dimensional transvaginal ultrasound data | BMC Women’s Health

The first 3D printing article in a gynecological application was reported by Stitely et al. 2016 about a clinical application of a 3D printed cylindrical tubing connector in 15th trimester dilation and evacuation procedures [12]. Meanwhile, Baek et al. provided accurate information about tumor margins through a 3D printed model of cervical cancer, which allowed the surgeon to choose the best alternative to preserve fertility [13]. Currently, an increasing number of 3D printed models apply to both diagnosis and pre-surgical planning of AUC. Tomlin K et al. accurately diagnosed a teenage girl with unilateral cervical atresia, obstructed hemi-vagina and ipsilateral renal abnormality with a 3D MRI printed model [8]. Barbosa MZ, et al. built a 3D model to improve reproductive surgery and IVF outcomes, including a uterine 3D model for uterine septum correction by hysteroscopic septoplasty [14]. Most gynecological 3D printing articles were based on data acquired by MRI or CT, especially MRI. To our knowledge, there are no publications regarding 3D printing for AUC based on ultrasound data.

As a reason why AUCs are associated with adverse reproductive effects [15], AUC detection has increased with the advent of 3D TVS. 3D TVS can provide visible evidence of the internal and external contours of the uterus and can assess uterine morphology with high accuracy compared to other commonly used radiological modalities. Again, 3D ultrasound is a non-invasive, reproducible and less expensive means, compared to MRI, which provides more information about the uterus in the coronal plane. Classification criteria for uterine anomalies based on 3D ultrasound have been described in the ESHRE/ESGE Thessaloniki Consensus on the Diagnosis of Female Genital Anomalies [16].

The main objective of the 3D printed models was to realize its clinical applications such as achieving better pre-surgical planning for hysteroscopic septoplasty, improving the precision of surgery and reducing iatrogenic risks for the patient, as hysteroscopic metroplasty of the uterine septum has become the current treatment of choice for patients with a septate uterus to maintain fertility [17]. 3D models of AUC have been constructed to allow the surgeon to assess the spatial location and spatial shape of the septum prior to surgery, thus avoiding unnecessary incisions. The 3D printed models would be helpful in predicting irregularities in the uterine cavity so that the human reproduction specialist can perform the technique accurately to improve the pregnancy rate. Moreover, the printed models were available in the operating room for any consultation before the intervention and for the explanation of the whole procedure to the patient, who considered the model very relevant for her understanding of the disease.

Improvements in computer-aided software, ultrasound imaging resolution, and materials engineering have enabled the development of 3D printing based on ultrasound data. To the best of our knowledge, our research and practice has made the first attempt at modeling AUCs based on 3D TVS data, confirming that building 3D printed models with high quality 3D-TVS scanning is perfectly feasible. The models provided strong contrast of uterine endometrium with stained material and myometrium with transparent material. It only took us 5-7 minutes to complete ultrasound image acquisition and data output, approximate time for data processing and printing was 4-5 hours. With the improvement of data post-processing and printing speed, the reduction of model building time is expected. Although time is not necessarily an issue for hysteroscopic septoplasty as an elective surgery.

The main limitation of this study is the small number of cases. Due to the fact that this was the first attempt to model AUCs based on 3D-TVS data, only four cases with different ACUs were included in the present study, resulting in less conviction, in particular a lack of statistical power, of its clinical application value. and the superiority of the technology itself. A large sample of subjects should be recruited for further validation.

As we know, building accurate 3D models in medicine requires a learning curve for both 3D model reconstruction engineers and radiologists who acquire 3D images to ensure printable file formats are created. [18], which requires multidisciplinary cooperation, especially extensive communication between clinician, radiologist and engineer is necessary when starting a model reconstruction. Given the wide applicability of 3D TVS in the diagnosis of AUC, our attempt confirmed the feasibility of printing 3D printed models based on ultrasound, can have a positive impact on individualized therapy in the field of gynecology.

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