Discussion
tumors
POSTOPERATIVE COMPLICATIONS, DISEASE, RECRUITMENT, TUMORS, COMPLICATIONS
The present study analyzes whether a personalized 3D-printed liver model manifests an educational benefit to patients, encourages their involvement in the decision-making process and thereby enhances patient’s satisfaction. As surgical procedures of the liver have become more complex and are frequently associated with postoperative complications, we applied patient questionnaires to examine the level of surgical comprehension and level of satisfaction with surgical education when 3D liver models were applied in addition to preexisting informational sheets. Overall, patient satisfaction with preoperative preparations was very high in general (Table The current study revealed that surgical education applying 3D models was associated with enhanced disease understanding as 3D-LiMo patients were significantly more likely to correctly point out the number of liver masses (100 vs. 70% in the 3D-LiMo and control groups, respectively; We were not able to detect an effect of the 3D model on patient satisfaction at the end of the hospital stay or at the follow-up appointment. We suggest that satisfaction levels at these time points are more dependent on the medical care at the surgical ward including nurses and physicians, occurrence of complications and the overall success of the surgery. The two study groups did not display a significant difference in morbidity, mortality, length of intensive care unit or total hospital stay.The present study has limitations. First, the pilot trial design of the study leads to a small study population of 40 patients in total. This small number of enrolled patients lowered the likelihood of detecting significant differences. Nevertheless, this study serves as proof of principle for the application of 3D liver visualization during preoperative consultation and the justification of future clinical studies. Second, this study was conducted as a single center experience. Nevertheless, as we aimed to assess educational benefit and satisfaction in patients, we suggest that this limitation did not affect our results and conclusions. Third, the high requirements of the CT scan and time expenditure of generating the 3D-printed models individually for each patient resulted in low recruitment rates. Resource-intensive, patient-specific 3D models pose an additional expenditure to hospitals. Despite this direct increase in financial costs, we suggest that application of 3D models reduce overall costs of hospitalization eventually. Despite our focus on improvement of patient’s literacy of their disease and the planned surgical procedure, we see the advantage of 3D models in their diverse application. Individualized 3D anatomical models of the liver can improve pre-operative planning through enhanced visualization of the specific patient’s liver anatomy and facilitated comprehension of anatomic relation of tumors to the intrahepatic vasculature [