As physicians increasingly face challenging surgical cases, new tools, like 3D printing, are helping them find viable solutions.

For example, a 64-year-old man came to Dr. Jon Zabaleta and his team with an extremely complicated tumour on his thoracic wall. Dr. Zabaleta is Thoracic Surgeon at Biodonostia, Health Research Institute, founded in 2008 as the first institute for medical research in the Basque region of Spain. Over the course of two years, the patient’s tumour had slowly grown up his chest cavity and spread across multiple ribs. The man was in intense pain, with surgeons concerned about his respiratory function.

“Ordinarily, in a case like this, we would remove the affected ribs and correct the defect by covering the area with a titanium plate,” says Dr. Zabaleta. “These plates are a standard size, designed for men of 100 KG or women of 50 KG, and need to be altered and rotated during surgery to suit each patient specification. In a complicated surgery, this can add hours to the operating time.”

In this case, removing the tumour would require removal of more than one rib, an unusual method of treatment that increased the risks associated with the surgery. As a result, the surgeons needed to find the best way to correct the defect with the strength to protect the lungs, while maintaining flexibility and movement in the chest.

To explore and plan the surgery, the surgeons turned to their partnership with Tknika and Tecnun to produce an advanced, patient-specific 3D model of the patient’s thoracic wall on a Stratasys Fortus 450mc 3D Printer. For the tumour, the surgeons required a model strong enough to replicate human bone. The teams at Tknika and Tecnun converted a conventional CT scan of the patient into an engineering-grade thermoplastic 3D printed model and returned it to the surgical team within 24 hours.

“By creating a precise, anatomically accurate 3D model of the thoracic wall, we were able to plan and perform the resection on the 3D model ahead of the surgery,” explains Dr. Zabaleta. “This allowed us to measure the screws and pre-bend the titanium plates and helped reduce the overall operating time by 2 hours. For the patient, this meant a significant reduction in time under anaesthesia, and for our hospital, freeing up time in operating rooms saves costs.”

Teamwork
Such a favourable outcome often involves research in seven subject areas that bring together more than 350 researchers across 26 groups. Daily, the Biodonostia, Health Research institute, and the co-located Donostia University Hospital where all treatment takes place, face challenging surgical cases. These all require precise, complex and often difficult surgeries during which surgeons need to make the most of every tool in their arsenal to ensure a safe clinical outcome.
Thanks to the partnership with Tknika, a Research and Applied Innovation Centre for Vocation Education and Training in the Basque region, and Tecnun, a specialist division of Universidad de Navarra, the surgical team has access to more advanced 3D printing technology.

“3D printing is an essential surgical tool for us,” explains Dr. Zabaleta. “Previously, no 3D printed model we created in-house could meet the level of detail and accuracy we needed. However, thanks to our partnership with these local institutions, we now have access to advanced 3D printing technology from Stratasys that enables us to meet the demands required to create highly-accurate, patient-specific 3D models.”

Our partnership afforded us access to the necessary technology to produce a large and complex model that was incredibly strong, close to the real bones we would face during surgery. Without the strength of this model, we could not have prepared for the surgery in the same way,” explains Dr. Zabaleta.

In addition, Dr. Zabaleta credits an improvement in patient-doctor communication to the 3D models. For the patient, using the 3D printed models to explain how they intended to protect his lungs helped to alleviate his anxiety ahead of a complicated operation and enabled informed consent. Additionally, the surgical consult was faster and more efficient.

Extending the use of 3D printing to other disciplines
Dr. Zabaleta believes that the next natural step will be for all surgical disciplines at Biodonostia to use Stratasys 3D printing to prepare and plan for surgeries, as it offers the hospital the opportunity to innovate their treatment procedures and improve patient care.

“The use of the 3D printed model was so essential to this case, and we are working to apply this to many other surgical disciplines across the hospital, from pancreatic tumours to airway stenosis, and these 3D printed models are already being used to help train our future surgeons,” explains Dr. Zabaleta.

Ultimately, the goal of the partnership with Tknika and Tecnun is to create a multi-disciplinary team that collaborates to create the best possible 3D printed surgical models for the hospital on-demand, with Tecnun’s involvement centering around the segmentation and reconstruction of the models, and Tknika producing the final 3D printed versions. But this collaboration is not just limited to Biodonostia, as the hospital is currently working to provide 3D printed models to 23 other hospitals across Spain.

“We’re thankful to have such knowledgeable partners in Tknika and Tecnun. Coupled with the dedicated local support of Stratasys distributor, Pixel Sistemas, we’re confident that the hospital can continue to help patients with access to the most advanced 3D printing solutions,” concludes Dr Zabaleta.

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