Domestic 3D printers: just another clinical tool in the hospital.

A fab lab in the hospital.

A team of orthopaedic surgeons from the Gregorio Marañón Hospital in Madrid is using 3D printing to plan and expedite surgical interventions.

Surgical advances are closely linked to the development of medical imaging technology. Surgeons have planned their operations using 3D imaging techniques for some years. They use programs that convert radiology studies into three-dimensional maps of the human body through which they can virtually navigate using their computers before entering the operating room.

Converting 2D images into 3D reconstructions represented a great advance for many specialists because it allows them to observe damaged tissues, bones or organs from all possible angles before facing them on the operating table. “For some 10 years now we have been using free software to create these virtual models from radiology studies. We use them to study cases and plan the best way to intervene”, explains Rubén Pérez Mañanes, associate doctor of traumatology and reconstructive surgery specialist. He is responsible for introducing domestic 3D printing applications into the Gregorio Marañón University Hospital (Madrid).

In this Madrilenian hospital, the Orthopaedic Surgery and Traumatology Service headed by professor Javier Vaquero now has the ideal tool to move forward and take these three-dimensional models to the tangible level: 3D desktop printers. They have become pioneers in transferring this household technology to the hospital sector.

"Being able to hold in our hands the PLA printed models of the fractures or tumours on which we're going to operate increases our capacity to prepare the intervention with greater accuracy".

"In fact, we can now anticipate some processes that we previously had to do during the actual operation. This reduces the time in the operating room and, by extension, the risk to the patient",  explains Doctor Pérez Mañanes.

Just another tool.

For these professionals, the Witbox 2 3D printer has become just another tool that helps with their daily work flow, together with medical scanners or computers. “It's the missing piece that completes the process”, adds the traumatologist. A process that starts with a scan or a resonance to diagnose the pathology, which then moves on to the creation and study of a virtual 3D model that helps with the planning of the operation, and which culminates with an intervention in the operating room.

“Now there is an intermediate step that gives us more information to prepare the operation and which also serves to explain the procedure to the patients”, explains José Antonio Calvo Haro, medical specialist in orthopaedic surgical oncology at the same hospital and who works with Pérez Mañanes on the inclusion of this technology into the centre. “We have created a work group in the hospital comprising different specialities to promote the use of this technology in our field, encouraging collective development and collaborative innovation”, adds Pérez Mañanes.

Surgical guides.

A practical example of the value of these printers in the planning phase is the creation of “surgical guides” for use in the operating room. “For years we have used these templates that are placed over the bones (previously sterilised). They indicate the spots where we have to insert screws, make cuts or adapt implants”, expounds Pérez Mañanes. These utensils are industrially manufactured by external suppliers.

“But now, with domestic 3D printing we can make these disposable guides ourselves”, he explains.

Another use they have come across for 3D printed parts is during the preparation of the implants before operating. Standard prostheses and plates need to be modelled over the patient's bone to shape them appropriately. Before these printers, implants were adapted during the operation. Now this adjustment can be completed before entering the operating room on a 3D printed replica of the damaged bone. “Or even during the actual operation but without having to do it on the patient, using instead a PLA printed model as a mould over which to shape the implant, expediting the operation and reducing associated risks. Furthermore, we are noticing a considerable improvement in precision with this method”, adds the traumatologist.

The models they manufacture are never implanted. “One mustn't mistake this for a prosthesis, under no circumstances does this part remain in a patient, they are only complementary tools, sterilised in the hospital, to be used in the surgical environment and later discarded”, he explains.

These parts are a complement that form part of their regular procedures. “We find domestic printers to be convenient and easy to use, the learning curve is short and we quickly discover new uses for them”, adds Calvo. This also helps to improve “touch”, a sense that is vital for surgeons.


A communication resource.

In fact, as well as being useful tools for surgeons, the models also serve to improve quality throughout the healthcare process.

“The models aid us in explaining the diagnosis, the alternatives and the type of intervention, to the patients”.

Having such visual and tactile properties makes it didactic and highly effective in helping patients understand the severity of their cases or how the operation will proceed. “Understanding the process gives them peace of mind and, in fact, many of our patients keep them as a memento”, he remarks.

And not only are these printed models useful for doctor-patient communication, they are also very effective in the medical training field. They are used to explain different surgical techniques to students and resident physicians. Apart from medical training, they are also effective in bioengineering and other related fields combining health and technology.

The maker spirit saves lives.

Pérez Mañanes, Calvo and the other specialists who have created this little “fab lab in the hospital” are not stopping here. Working side by side with clinics and researchers from the centre, they have begun “reverse engineering”, that is, scanning their hospital utensils to study their designs and consider new alternatives.

"We print all sorts of prototype gadgets that help us in our day to day, from finger immobilisation splints to boxes and supports for medical consumables, or supports to position cameras in the operating room".

Taking control over the creation process allows them to make tools adapted to their real needs. “Manufacturing these tools ourselves in our own facility, rather than depending on third parties, gives us greater control over the healthcare process as a whole, from diagnosis to intervention. This also generates considerable cost savings”,adds Pérez Mañanes.

Another of the projects where the “maker spirit” is assisting with health involves the use of 3D printers in regions with scarce resources or which have suffered some type of catastrophe or war. “In places where one can't rely on the necessary surgical material being available, and where there are very specific necessities, a 3D printer can save costs and solve many medical problems”, says the traumatologist.

Solving problems and saving on costs are the main advantages these surgeons have discovered when employing this household tool in the operating room. They encourage others to try them out and “discover new uses”, according to Pérez Mañanes.

“The more we use them, the more ideas arise on how they can facilitate our daily activity and the success of our interventions”.