3D printers in the operating room

In recent years, 3D print­ing has become an import­ant tech­no­logy for medi­cine, espe­cially in the field of pros­thet­ics for dent­al or bone implants, but also for the sub­sti­tu­tion of ampu­tated limbs or skin recon­struc­tion for burn vic­tims. More recently, oth­er med­ic­al fields, such as car­di­ology, uro­logy or neurosur­gery have also star­ted to take an interest in addit­ive man­u­fac­tur­ing. Moreover, ongo­ing research seeks to improve bioprint­ing of organs or tis­sues as a way to over­come the lack of organ donors. And the phar­ma­ceut­ic­al sec­tor is try­ing to devel­op med­ic­a­tion with nov­el shapes or properties.

Cus­tom­ised print­ing of med­ic­al equipment

The great advant­age of 3D print­ing is its cus­tom­isa­tion capa­cit­ies: dent­al implants, hip, rib, sternum or knee pros­theses. Hear­ing aids or ortho­paed­ic insoles can also be prin­ted as one-off objects, tailored to the needs of each patient. Bern­ardo Inno­centi, pro­fess­or in bio­mech­an­ics at École poly­tech­nique of the Uni­versité Libre de Bruxelles and pres­id­ent of the Bel­gian com­pany CAOS (Com­puter Assisted Ortho­paed­ic Sur­gery) works in col­lab­or­a­tion with ortho­paed­ic sur­geons and, more spe­cific­ally, with spe­cial­ists in knee surgery.

He explains that the use of addit­ive man­u­fac­tur­ing in sur­gery is an inter­dis­cip­lin­ary field, which entails ongo­ing dia­logue between sur­geons, research­ers and engin­eers. In his opin­ion, the inter­ac­tion between these pro­fes­sion­als is the key to suc­cess for a bio­med­ic­al product and a patient’s recov­ery after sur­gery. “3D print­ing is not only used to make implants, it also provides the sur­geon with a max­im­um of import­ant inform­a­tion on the organ before the sur­gic­al procedure,”he explains.

Pre­par­ing sur­gic­al procedures

Indeed, in the pre­op­er­at­ive phase print­ing a three-dimen­sion­al rep­lica of the body part can help col­lect vital inform­a­tion some­times impossible to obtain without this tech­no­logy. The sur­geon can thus hold in his hand the bone or the joint, and gain pre­cise know­ledge on the shape, size, tact­ile char­ac­ter­ist­ics, and the extent of the damage.

“Today, by using dif­fer­ent col­ours and print­ing mater­i­als, we can truly sim­u­late the bone and define areas of high or low bone dens­ity to decide where to put the screws and plates,” states Bern­ardo Inno­centi. 3D print­ing can also be used to make per­son­al­ised sur­gic­al instru­ments, guar­an­tee­ing a cus­tom pro­ced­ure for each patient based on the dis­tinct pos­i­tion of their muscles and ten­dons. Sur­gic­al tem­plates, for example, help the sur­geon to define the cut­ting tem­plate and incision points.

In the post-oper­at­ive phase

Addit­ive man­u­fac­tur­ing could also prove use­ful in the post-oper­at­ive phase, to mon­it­or the growth of bone and prostheses/bone integ­ra­tion. Although, they are com­pet­ing with pre-exist­ing meth­ods that are argu­ably less expens­ive and already very efficient.

Bern­ardo Inno­centi insists that the use of addit­ive man­u­fac­tur­ing in sur­gery has huge advant­ages if all the steps are per­formed with extreme pre­ci­sion, but also if you have the neces­sary means and time. Indeed, the inter­ac­tions between doc­tors and engin­eers, as well as the design and the mod­el­ling of the pros­theses or implants, all require addi­tion­al delays, while the man­u­fac­tur­ing and install­a­tion times dur­ing the sur­gery are sim­il­ar to oth­er techniques.

“Though it might take a few years for 3D print­ing to become widely accep­ted by prac­ti­tion­ers, we are already see­ing an import­ant dis­sem­in­a­tion of know­ledge in med­ic­al schools”, states Bern­ardo Inno­centi. “In the case of rare dis­eases, 3D print­ing could even help to build a data­base to train young surgeons.”

Recently, he even star­ted to work in the field of car­di­ology, anoth­er sec­tor in which the use of addit­ive man­u­fac­tur­ing is on the rise. “As in the case of the ortho­paed­ic sec­tor, 3D print­ing is not only used to man­u­fac­ture pro­theses (valves and stents) but also because it is very pre­cise dur­ing the sur­gery. Addit­ive man­u­fac­tur­ing does not just upgrade equip­ment and med­ic­a­tion, it also improves ther­apy as a whole,” con­cludes Bern­ardo Innocenti.