Gautam Gupta – vice president and general manager, medical devices, 3D Systems, explains how 3D printing technology is used to design patient-specific tools and guides to help improve surgical outcomes.
Healthcare is one of the most dynamic fields of technology. The speed at which innovation is occurring — from the way surgeries are performed, to the development of new therapies — is moving ever more rapidly.
Unfortunately, despite all these advances, findings by the World Health Organisation suggest that globally, surgery still results in high rates of illness, disease, and death. Unsafe surgical care procedures cause complications in up to 25% of patients. Almost seven million surgical patients suffer significant complications, one million of whom die during or immediately following surgery. 3D printing has been recognised for its ability to enable the creation of personalised surgical plans and tools, thus helping improve patient outcomes.
3D Systems was an early innovator in the field through the introduction of our VSP surgical planning solutions whereby we combine expertise in medical imaging, surgical simulation, and 3D printing to enable personalised surgery - allowing surgeons to perform the surgery digitally before entering the operating room.
Patient-specific models & tools improve accuracy and efficiency
To create patient-specific models and tools, the clinician must first begin with scans of the patient’s anatomy. Today, D2P - an FDA-cleared, CE-marked software - is available that relies on automatic segmentation tools driven by deep learning enabling medical practitioners to create accurate, digital 3D anatomic models from medical imaging data. D2P also includes a volumetric VR solution enabling instant views of patient scans in a 3D environment - facilitating conversations between medical staff and their patients.
The segmented anatomy, in combination with a pre-surgical plan and an appropriate quality management system, allows for the design of patient-specific anatomic models, surgical instruments, and implants. This can be accomplished using organic 3D design software such as Geomagic Freeform that includes advanced design tools for working with complex, organic shapes like patient anatomic structures. This software facilitates user-friendly interaction with objects to create precise, patient-matched medical device designs for instruments and implants. These devices can then be 3D printed in biocompatible materials like titanium alloy or a variety of polymers for use within the sterile surgical field.
Pre-surgical planning in combination with patient-specific surgical instruments allows the surgeon to focus on giving the patient the best possible outcome. In clinical applications where VSP is used today, the solutions have been shown to improve surgical accuracy and outcomes -- saving time in the operating room which benefits both the surgeon and the patient. Designing the optimal surgical plan also includes considering the procedure in a less invasive way, helping to reduce the length of stay, and ultimately overall healthcare costs.
This can be illustrated by a case that allowed 3D Systems’ biomedical engineers to collaborate with Dr. Oren Tepper, attending surgeon, Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, in planning and conducting ground-breaking surgery on a young girl who was born with an undersized jaw that inhibited her breathing. Traditionally in such cases, surgeons have been unable to perform the surgeries required to reshape a child’s jaw due to the pain and risks associated while the patient is very young. However, VSP technology-enabled Dr. Tepper to successfully correct the child’s jaw much earlier than is typical, at one month old as opposed to six-years-old, sparing her additional years of living with a tracheostomy.
Revolutionary approach at the point of care
Since our VSP surgical panning solutions first became available, the patient-specific models, tools, and instruments have been 3D printed at a 3D Systems location, and shipped to the surgeon. While efficient, healthcare providers have become increasingly reliant on innovation to improve patient care. With the advent of the global pandemic, supply chains and timely delivery of healthcare was put to the test, and additive manufacturing demonstrated its power as an enabling solution.
As the number of COVID-19 cases increased, healthcare workers needed increased volumes of PPE to treat patients. Additionally, the need for ventilators was growing exponentially and production lines came to a halt as raw materials were unavailable. It was very apparent how the pandemic disrupted supply chains and additive manufacturing (AM) was highlighted for its ability to rapidly adapt with new designs to produce the necessary items. When it came to manufacturing of nasopharyngeal swabs, for example, AM enabled rapid innovation via multiple design and material iterations to launch a product that could be mass-produced cost-effectively.
As the pandemic brought into focus, any sort of distance between where the patient-specific models, tools, and instruments are created, and where the surgery is performed has a direct impact on patient treatment. If these capabilities could be located within the healthcare institution – at the point of care - the planning and delivery time could be condensed.
This is already occurring at some of the world’s elite hospitals where clinicians can create customised solutions for patient care by using AM solutions available to them on campus.
For instance, Professor Samer Saruji leads the Craniomaxillofacial Surgery unit at Galilee Medical Center (Nahariya, Israel), which includes a 3D printing lab. This is the first — and currently, only — centre in Israel that has an in-house end-to-end surgical planning workflow, in which physicians have the know-how to use 3D Systems’ surgical planning applications and 3D printing.
Despite only just starting to use this workflow in their daily practice, Professor Saruji said: “We already see the great progress in our patient outcome. The errors are dramatically reduced, and the surgical ability of the surgeon is constantly improving. Also, having those capabilities in-house helps us to reduce procedural cost.”
3D printing is accelerating healthcare innovation, yet at the point of care, I believe this technology is still in its infancy. As the technology becomes more user-friendly for medical professionals, more hospitals will be able to implement end-to-end solutions for personalised surgery. This will disrupt existing healthcare models, improve the quality of care, and crucially, save more lives.
