Application and effectiveness of an innovative three-dimensional printing model combined with three-dimensional visualization in teaching thoracoscopic sublobar resection: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MIAO Yafei ^1,2 , YU Qing ^1,2 , ZHANG Ziheng ^1,2 , LIU Changjiang ⁶ , GUO Qiang ^1,5 , LI Hefei ^1,5 ,  ZHANG Ke ^1,3,4,5,7,8

1. Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, 071000, Hebei, P. R. China;
2. Clinical Medical College of Hebei University, Baoding, 071000, Hebei, P. R. China;
3. 3D Image and 3D Printing Center, Affiliated Hospital of Hebei University, Baoding, 071000, Hebei, P. R. China;
4. Basic Research Key Laboratory of General Surgery for Digital Medicine, Baoding, 071000, Hebei, P. R. China;
5. Institute of Life Science and Green Development, Hebei University, Baoding, 071000, Hebei, P. R. China;
6. Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, P. R. China;
7. The First Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, P. R. China;
8. Hebei Hospital, Xuanwu Hospital of Capital Medical University, Shijiazhuang, 050000, Hebei, P. R. China;

Corresponding?author：

ZHANG Ke, Email: 93391@qq.com

Keywords：

Three-dimensional visualization; three-dimensional printing; sublobar resection; medical education; randomized controlled trial

DOI：

10.7507/1007-4848.202508048

Video：

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Objective To evaluate the effectiveness of combining three-dimensional printing (3DP) models with three-dimensional visualization (3DV) technology in the teaching of thoracoscopic sublobar resection. Methods From March 2024 to June 2025, 150 interns were randomly assigned by envelope method to the 3DV, 3DP, and combined (3DV+3DP) groups. Three theoretical tests and score changes were used to assess short- and long-term teaching outcomes, and a questionnaire survey was conducted to analyze learning experience. Results After teaching, scores improved significantly in all groups (P<0.001), with the greatest increase in the combined group (47.18±5.81), which was higher than the 3DV and 3DP groups (P<0.001 and P=0.002, respectively). At 1 month, scores declined in all groups (P=0.028), but the combined group showed the smallest decrease (?6.94 ± 6.05). The combined group also showed the most pronounced advantage in spatial cognition (38.0%). Conclusion Innovative 3DP+3DV instructional model improves sublobar lung resection teaching and shows better long-term retention and spatial cognition.

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2.	Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2022, 163(1): 289-301.
3.	Aokage K, Suzuki K, Saji H, et al. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): a multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med, 2023, 11(6): 540-549.
4.	胡堅, 支修益, 劉倫旭. 直徑≤2 cm肺結節胸外科合理診療中國專家共識(2024). 中國胸心血管外科臨床雜志, 2024, 31(8): 1077-1089.Hu J, Zhi XY, Liu LX. Chinese expert consensus on the rational diagnosis and treatment of pulmonary nodules ≤2 cm (2024). Chin J Clin Thorac Cardiovasc Surg, 2024, 31(8): 1077-1089.
5.	Liu Y, Qiu B, Zhang S, et al. A simplified model for determining the cutting plane during thoracoscopic anatomical partial lobectomy of the right lower lobe. Transl Lung Cancer Res, 2021, 10(7): 3203-3212.
6.	王蕾, 向之明. 人工智能聯合三維重建在胸腔鏡肺結節切除術中的應用進展. 中國胸心血管外科臨床雜志, 2025, 32(02): 252-257.Wang L, Xiang ZM. Application progress of artificial intelligence combined with three-dimensional reconstruction in thoracoscopic pulmonary nodule resection. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(02): 252-257.
7.	Miao H, Ding J, Gong X, et al. Application of 3D-printed pulmonary segment specimens in experimental teaching of sectional anatomy. BMC Surg, 2023, 23(1): 360.
8.	Ghosh SK. Paying respect to human cadavers: we owe this to the first teacher in anatomy. Ann Anat, 2017, 211: 129-134.
9.	Ero?lu FS, Erkan B, Koyuncu SB, et al. Effectiveness of using 2D atlas and 3D PDF as a teaching tool in anatomy lectures in initial learners: a randomized controlled trial in a medical school. BMC Med Educ, 2023, 23(1): 588.
10.	張欣宇, 李林倩, 李浩然, 等. 計算機輔助設計修飾的3D打印模型在電視輔助胸腔鏡亞肺葉切除術治療早期肺癌中的應用. 中國胸心血管外科臨床雜志, 2024: 1-7.Zhang XY, Li LQ, Li HR, et al. Application of computer-aided design modified 3D printing model in video-assisted thoracoscopic segmentectomy for early-stage lung cancer. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(2): 252-257.
11.	Brumpt E, Bertin E, Tatu L, et al. 3D printing as a pedagogical tool for teaching normal human anatomy: a systematic review. BMC Med Educ, 2023, 23(1): 930.
12.	Sweller J, Van Merrienboer JJG, Paas FGWC. Cognitive architecture and instructional design. Educ Psychol Rev, 1998, 10(3): 251-296.
13.	Mayer RE. The past, present, and future of the cognitive theory of multimedia learning. Educ Psychol Rev, 2024, 36(1): 31.
14.	Akta? N, Atabek D, Tun? O. Innovative 3D-printed educational models for vital pulp treatments and local anesthesia training in pediatric dentistry. BMC Med Educ, 2025, 25(1): 1122.
15.	張躍川, 彭越, 惠尚懿, 等. 3D打印技術在脊柱外科手術中應用的可視化文獻計量學分析. 中華骨與關節外科雜志, 2024, 17(06): 485-496.Zhang YC, Peng Y, Hui SY, et al. Visual bibliometric analysis of the application of 3D printing technology in spinal surgery. Chin J Bone Joint Surg, 2024, 17(06): 485-496.
16.	亓旭晨, 胡燁婷, 張小兵. 3D打印教具結合CBL教學法在神經外科住培中的應用. 中國繼續醫學教育, 2024, 16(13): 97-101.Qi XC, Hu YT, Zhang XB. Application of 3D printing teaching aids combined with CBL teaching method in neurosurgery residency training. Chin Cont Med Educ, 2024, 16(13): 97-101.
17.	凌云飛, 鐘詩童, 范強, 等. 3D打印室間隔缺損模型在心臟外科年輕醫生培養中的作用. 中國胸心血管外科臨床雜志, 2024, 31(09): 1338-1344.Ling YF, Zhong ST, Fan Q, et al. Role of 3D printed ventricular septal defect model in the training of young cardiac surgeons. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(09): 1338-1344.
18.	Li L, Cheng S, Li J, et al. Randomized comparison of AI enhanced 3D printing and traditional simulations in hepatobiliary surgery. NPJ Digit Med, 2025, 8(1): 293.
19.	Schlegel L, Ho M, Fields JM, et al. Standardizing evaluation of patient-specific 3D printed models in surgical planning: development of a cross-disciplinary survey tool for physician and trainee feedback. BMC Med Educ, 2022, 22(1): 862.
20.	Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care, 2003, 41(5): 582-592.
21.	盧斌, 倪晨明, 馬洪運, 等. 3D打印技術在肝膽外科教學中的應用. 醫學教育管理, 2023, 9(02): 206-211.Lu B, Ni CM, Ma HY, et al. Application of 3D printing technology in hepatobiliary surgical education. Med Educ Manag, 2023, 9(02): 206-211.
22.	畢思偉, 周彥楠, 古君, 等. 3D打印心臟模型對先天性心臟病教學效果影響的系統評價與Meta分析. 中國胸心血管外科臨床雜志, 2024, 31(08): 1101-1108.Bi SW, Zhou YN, Gu J, et al. Systematic review and meta-analysis of the impact of 3D printed heart models on teaching outcomes of congenital heart disease. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(08): 1101-1108.
23.	Goyal S, Chua CXK, Chen YS, et al. Utility of 3D printed models as adjunct in acetabular fracture teaching for orthopaedic trainees. BMC Med Educ, 2022, 22(1): 732.

1. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
2. Suzuki K, Watanabe SI, Wakabayashi M, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg, 2022, 163(1): 289-301.
3. Aokage K, Suzuki K, Saji H, et al. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): a multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med, 2023, 11(6): 540-549.
4. 胡堅, 支修益, 劉倫旭. 直徑≤2 cm肺結節胸外科合理診療中國專家共識(2024). 中國胸心血管外科臨床雜志, 2024, 31(8): 1077-1089.Hu J, Zhi XY, Liu LX. Chinese expert consensus on the rational diagnosis and treatment of pulmonary nodules ≤2 cm (2024). Chin J Clin Thorac Cardiovasc Surg, 2024, 31(8): 1077-1089.
5. Liu Y, Qiu B, Zhang S, et al. A simplified model for determining the cutting plane during thoracoscopic anatomical partial lobectomy of the right lower lobe. Transl Lung Cancer Res, 2021, 10(7): 3203-3212.
6. 王蕾, 向之明. 人工智能聯合三維重建在胸腔鏡肺結節切除術中的應用進展. 中國胸心血管外科臨床雜志, 2025, 32(02): 252-257.Wang L, Xiang ZM. Application progress of artificial intelligence combined with three-dimensional reconstruction in thoracoscopic pulmonary nodule resection. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(02): 252-257.
7. Miao H, Ding J, Gong X, et al. Application of 3D-printed pulmonary segment specimens in experimental teaching of sectional anatomy. BMC Surg, 2023, 23(1): 360.
8. Ghosh SK. Paying respect to human cadavers: we owe this to the first teacher in anatomy. Ann Anat, 2017, 211: 129-134.
9. Ero?lu FS, Erkan B, Koyuncu SB, et al. Effectiveness of using 2D atlas and 3D PDF as a teaching tool in anatomy lectures in initial learners: a randomized controlled trial in a medical school. BMC Med Educ, 2023, 23(1): 588.
10. 張欣宇, 李林倩, 李浩然, 等. 計算機輔助設計修飾的3D打印模型在電視輔助胸腔鏡亞肺葉切除術治療早期肺癌中的應用. 中國胸心血管外科臨床雜志, 2024: 1-7.Zhang XY, Li LQ, Li HR, et al. Application of computer-aided design modified 3D printing model in video-assisted thoracoscopic segmentectomy for early-stage lung cancer. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(2): 252-257.
11. Brumpt E, Bertin E, Tatu L, et al. 3D printing as a pedagogical tool for teaching normal human anatomy: a systematic review. BMC Med Educ, 2023, 23(1): 930.
12. Sweller J, Van Merrienboer JJG, Paas FGWC. Cognitive architecture and instructional design. Educ Psychol Rev, 1998, 10(3): 251-296.
13. Mayer RE. The past, present, and future of the cognitive theory of multimedia learning. Educ Psychol Rev, 2024, 36(1): 31.
14. Akta? N, Atabek D, Tun? O. Innovative 3D-printed educational models for vital pulp treatments and local anesthesia training in pediatric dentistry. BMC Med Educ, 2025, 25(1): 1122.
15. 張躍川, 彭越, 惠尚懿, 等. 3D打印技術在脊柱外科手術中應用的可視化文獻計量學分析. 中華骨與關節外科雜志, 2024, 17(06): 485-496.Zhang YC, Peng Y, Hui SY, et al. Visual bibliometric analysis of the application of 3D printing technology in spinal surgery. Chin J Bone Joint Surg, 2024, 17(06): 485-496.
16. 亓旭晨, 胡燁婷, 張小兵. 3D打印教具結合CBL教學法在神經外科住培中的應用. 中國繼續醫學教育, 2024, 16(13): 97-101.Qi XC, Hu YT, Zhang XB. Application of 3D printing teaching aids combined with CBL teaching method in neurosurgery residency training. Chin Cont Med Educ, 2024, 16(13): 97-101.
17. 凌云飛, 鐘詩童, 范強, 等. 3D打印室間隔缺損模型在心臟外科年輕醫生培養中的作用. 中國胸心血管外科臨床雜志, 2024, 31(09): 1338-1344.Ling YF, Zhong ST, Fan Q, et al. Role of 3D printed ventricular septal defect model in the training of young cardiac surgeons. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(09): 1338-1344.
18. Li L, Cheng S, Li J, et al. Randomized comparison of AI enhanced 3D printing and traditional simulations in hepatobiliary surgery. NPJ Digit Med, 2025, 8(1): 293.
19. Schlegel L, Ho M, Fields JM, et al. Standardizing evaluation of patient-specific 3D printed models in surgical planning: development of a cross-disciplinary survey tool for physician and trainee feedback. BMC Med Educ, 2022, 22(1): 862.
20. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care, 2003, 41(5): 582-592.
21. 盧斌, 倪晨明, 馬洪運, 等. 3D打印技術在肝膽外科教學中的應用. 醫學教育管理, 2023, 9(02): 206-211.Lu B, Ni CM, Ma HY, et al. Application of 3D printing technology in hepatobiliary surgical education. Med Educ Manag, 2023, 9(02): 206-211.
22. 畢思偉, 周彥楠, 古君, 等. 3D打印心臟模型對先天性心臟病教學效果影響的系統評價與Meta分析. 中國胸心血管外科臨床雜志, 2024, 31(08): 1101-1108.Bi SW, Zhou YN, Gu J, et al. Systematic review and meta-analysis of the impact of 3D printed heart models on teaching outcomes of congenital heart disease. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(08): 1101-1108.
23. Goyal S, Chua CXK, Chen YS, et al. Utility of 3D printed models as adjunct in acetabular fracture teaching for orthopaedic trainees. BMC Med Educ, 2022, 22(1): 732.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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