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.