Patient-specific, deliverable, and self-expandable surgical guide development and evaluation using 4D printing for...

Area of Science:

• Surgical Innovation
• Medical Device Engineering
• Urological Oncology

Background:

• Advances in computed tomography (CT) and minimally invasive surgery have improved partial nephrectomy outcomes.
• Accurate delineation of the kidney resection margin during laparoscopy remains a significant surgical challenge.
• Precise surgical guides are needed to enhance accuracy and reproducibility in partial nephrectomy procedures.

Purpose of the Study:

• To fabricate and evaluate a 4D-printed kidney surgical guide (4DP-KSG) for laparoscopic partial nephrectomies.
• To assess the accuracy of the 4DP-KSG in marking kidney resection areas based on CT imaging.
• To determine the guide's performance and consistency across multiple operators.

Main Methods:

• A 4DP-KSG was designed using CT images from a renal cell carcinoma patient.
• The guide was fabricated from shape-memory polymers and compressed to simulate laparoscopic port passage.
• Bland-Altman analysis evaluated the shape and marking accuracy of the 4DP-KSG before and after compression.

Main Results:

• The 4DP-KSG demonstrated high shape accuracy (0.389 ± 0.243 mm after restoration).
• Marking accuracy was also precise (0.793 ± 0.677 mm after restoration).
• No significant differences in accuracy were found between operators or between pre- and post-compression states.

Conclusions:

• The 4D-printed kidney surgical guide (4DP-KSG) is a viable tool for laparoscopic partial nephrectomies.
• The 4DP-KSG provides precise and quantitative marking of kidney tumors, enhancing surgical planning.
• The guide's accuracy and consistency support its clinical application in minimally invasive renal surgery.