Dear Editor,

We would like to share ideas on the publication entitled “Improved graft survival by using three-dimensional printing of intra-abdominal cavity to prevent large-for-size syndrome in liver transplantation [1].” This work suggests a novel use of three-dimensional (3D)-printed abdominal models to enhance liver transplant results for individuals with small bodies. While these anatomic modeling techniques seem novel and could enhance surgical accuracy, we have significant concerns about its research methodology and results. Although the decision to use propensity score-matched analyses is widely regarded as reasonable, questions regarding statistical power and generalizability are raised by a comparatively small sample size (20 patients in the intervention group compared to 100 patients in the control group). The effectiveness of such a radical intervention might have been understated in this small community. Bigger population studies are required to corroborate these findings.

This study could have benefited from a more precise definition of “clinical outcome” in addition to the size of its sample. Although the authors discussed transplant survival and postoperative problems, they did not go into great detail on the type or severity of these side effects. To better understand the safety profile of using 3D-printed models, more specific information about the types of issues could be useful. Furthermore, there was a paucity of information in the study regarding the precise surgical methods employed by various surgeons, which might have contributed to variations in its results. Could there have been a bias in results because surgeons using those models were more skilled or specialized? Conclusions made in that study might have been supported more strongly by a more thorough explanation.

Future steps might involve increasing the sample size and incorporating long-term follow-up evaluations to gauge the quality of life of patients after transplantation in addition to graft survival. Examining how the 3D model can be used for different patient demographics or surgical techniques could yield more comprehensive understanding of the model’s usefulness in medicine. The authors can even go one step further and investigate how preoperative planning might be enhanced by integrating virtual reality or simulation technologies. This extra dimension will enable a customized strategy based on distinct anatomical requirements of every patient.

Lastly, given the encouraging outcomes regarding graft survival, additional research may look into processes underlying this improvement. Are there any particular aspects of the 3D model that facilitate more effective graft placement planning or execution? Qualitative analysis, which incorporates input from patients and surgeons, can offer important new perspectives on advantages and drawbacks of using 3D models in surgery. The authors hope to enhance the role of 3D printing technology in enhancing surgical outcomes in transplantation and other fields by providing answers to these important concerns and broadening the scope of their research.

None.

No potential conflict of interest relevant to this article was reported.

Conceptualization: All authors. Formal analysis: HD. Supervision: VW. Writing - original draft: All authors. Writing - review & editing: All authors.