Orthopaedic surgeons using 3D printed models to prepare for surgery: a qualitative investigation
TL;DR
There was very often an overlap in the discussion of 3DP for surgeon training and for experienced surgeons preparing for something new and complex, which underscored the concept of surgical practice being a continuous embodied process.
Abstract
With the recent accessibility of 3D printing (3DP), many orthopaedic surgeons have taken up 3DP for pre-operative planning and rehearsal. The aim was to label and categorize perceived benefits of using 3DP anatomical models in preparation for surgery, and how they regard its future use in training. We employed a qualitative explorative design using a phenomenological approach. In-depth, semi-structured interviews with 10 orthopaedic surgeons based at a training hospital were transcribed and imported into ATLASti for analysis. We used an inductive coding approach performed by three of the authors. Individual coding was compared and adjusted by an iterative process. Two main themes emerged: perceived benefits and surgeon attitudes. Four subthemes included: pre-operative benefits, intra-operative benefits, post operative benefits and effect on competence and training. All the surgeons reported that having 3DP models of patient imaging positively influenced surgical preparation. Most described the models as an adjunct to image interpretation. In several cases, participants reported rehearsing a procedure more than once to test out strategies and implants. Intra-operative benefits included increased confidence in the theatre and a sense of ‘déjà vu’ when operating. Many participants mentioned a perceived increase in surgeon skill and 3DP being a valuable training tool. Several surgeons mentioned a perceived decrease in theatre times and a perceived increase in surgical accuracy. Surgeon attitudes to medical 3DP were most frequently about how the models can be modified for improved pre-operative rehearsal. Most mentioned that they are expecting the technology to develop, and this co-occurred with an intention to proactively engage with the technology. Other ideas that occurred were that planning with 3DP is not essential for all cases, but that it would become essential for some cases. Recent publications about the use of 3DP in healthcare have risen dramatically and the use in pre-operative planning is a major theme. However, most studies focus on more objective outcomes like operative time, blood loss, fluoroscopic usage and surgical accuracy. However, blood loss, fluoroscopic usage and hospital stay were not mentioned by participants. A benefit of using 3DP might be that it moves critical decision-making points to the pre-operative phase, decreasing cognitive load experienced in theatre. There was very often an overlap in the discussion of 3DP for surgeon training and for experienced surgeons preparing for something new and complex, which underscored the concept of surgical practice being a continuous embodied process. Future directions for research could investigate how perceived benefits link with existing models of cognitive load and fatigue accumulation in theatre, linking it to more measurable outcomes.