Vinay Dhir1, Takao Itoi2, Paul Fockens3, Manuel Perez-Miranda4, Mouen A Khashab5, Dong Wan Seo6, Ai Ming Yang7, Khek Yu Lawrence8, Amit Maydeo1. 1. Baldota Institute of Digestive Sciences, Mumbai, India. 2. Tokyo Medical University, Tokyo, Japan. 3. Academic medical Centre, Amsterdam, Netherlands. 4. Valladolid University Medical School, Valladolid, Spain. 5. Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 6. Asan Medical Center, Seoul, South Korea. 7. Peking University Medical Center Hospital, Beijing, China. 8. National University Health System, Singapore.
Abstract
BACKGROUND: EUS-guided biliary drainage (EUS-BD) has emerged as an alternative rescue method in patients with failed ERCP. Opportunities for teaching and training are limited because of a low case volume at most centers. OBJECTIVE: To evaluate a stereolithography/3-dimensional (3D) printing bile duct prototype for teaching and training in EUS-BD. DESIGN: Prospective observational feasibility study. SETTING: Tertiary referral center. SUBJECTS: Twenty endosonographers attending an interventional EUS workshop. INTERVENTION: A prototype of a dilated biliary system was prepared by computer-aided design and 3D printing. The study participants performed guidewire manipulation and EUS-BD procedures (antegrade procedure and/or choledochoduodenostomy) on the prototype. Participants were scored with the device on a scale of 1 to 5 via a questionnaire. Participants' success rate for various steps of the EUS-BD procedure was noted. MAIN OUTCOME MEASUREMENTS: Subjective and objective evaluation of the prototype regarding its overall applicability, quality of radiographic and EUS images, and 4 steps of EUS-BD procedure (needle puncture, guidewire manipulation, tract dilation, stent placement). RESULTS: Fifteen participants returned the questionnaire, and 10 completed all 4 steps of EUS-BD. The median score for overall utility was 4, whereas that for EUS and US views was 5. Participants with experience in performing more than 20 EUS-BD procedures scored the prototype significantly lower for stent placement (P = .013) and equivalent for needle puncture, tract dilation, and wire manipulation. The success rate of various steps was 100% for needle puncture and tract dilation, 82.35% for wire manipulation, and 80% for stent placement. The mean overall procedure time was 18 minutes. LIMITATIONS: Small number of participants. CONCLUSION: The 3D printing bile duct prototype appears suitable for teaching of and training in the various steps of EUS-BD. Further studies are required to elucidate its role.
BACKGROUND: EUS-guided biliary drainage (EUS-BD) has emerged as an alternative rescue method in patients with failed ERCP. Opportunities for teaching and training are limited because of a low case volume at most centers. OBJECTIVE: To evaluate a stereolithography/3-dimensional (3D) printing bile duct prototype for teaching and training in EUS-BD. DESIGN: Prospective observational feasibility study. SETTING: Tertiary referral center. SUBJECTS: Twenty endosonographers attending an interventional EUS workshop. INTERVENTION: A prototype of a dilated biliary system was prepared by computer-aided design and 3D printing. The study participants performed guidewire manipulation and EUS-BD procedures (antegrade procedure and/or choledochoduodenostomy) on the prototype. Participants were scored with the device on a scale of 1 to 5 via a questionnaire. Participants' success rate for various steps of the EUS-BD procedure was noted. MAIN OUTCOME MEASUREMENTS: Subjective and objective evaluation of the prototype regarding its overall applicability, quality of radiographic and EUS images, and 4 steps of EUS-BD procedure (needle puncture, guidewire manipulation, tract dilation, stent placement). RESULTS: Fifteen participants returned the questionnaire, and 10 completed all 4 steps of EUS-BD. The median score for overall utility was 4, whereas that for EUS and US views was 5. Participants with experience in performing more than 20 EUS-BD procedures scored the prototype significantly lower for stent placement (P = .013) and equivalent for needle puncture, tract dilation, and wire manipulation. The success rate of various steps was 100% for needle puncture and tract dilation, 82.35% for wire manipulation, and 80% for stent placement. The mean overall procedure time was 18 minutes. LIMITATIONS: Small number of participants. CONCLUSION: The 3D printing bile duct prototype appears suitable for teaching of and training in the various steps of EUS-BD. Further studies are required to elucidate its role.
Authors: Muhammad Ali Khan; Ali Akbar; Todd H Baron; Sobia Khan; Mehmat Kocak; Yaseen Alastal; Tariq Hammad; Wade M Lee; Aijaz Sofi; Everson L A Artifon; Ali Nawras; Mohammad Kashif Ismail Journal: Dig Dis Sci Date: 2015-10-30 Impact factor: 3.199
Authors: Michael A Bohl; James J Zhou; Michael A Mooney; Garrett J Repp; Claudio Cavallo; Peter Nakaji; Steve W Chang; Jay D Turner; U Kumar Kakarla Journal: J Spine Surg Date: 2019-03