In manufacturing, fabricated jigs and tools help accelerate the speed of the production line. They help workers align parts, components and assemblies with precision.
The same effective technology may be used to help surgeons and physicians in performing very complex medical procedures where precision is paramount. By using available imaging data, surgical teams are able to produce models and create guides that expedite very delicate parts of surgical procedures. They help a skilled surgeon put their full skill to work.
Renishaw is a UK company with core skills in measurement, motion control, spectroscopy and precision machining. They use 3D tooling and 3D printing as part of their design process for many products – including medical devices and applications.
A 3D printed skull complete with jaw tumor printed on a Stratasys J750 3D printer.
Ed Littlewood is marketing manager of their Medical and Dental Products Division. He says 3D printing continues to make great contributions to medicine in aiding practitioners and believes we can expect to see more progress and use as the value of additive manufacturing is realized to create jigs and guides to help surgeons. Littlewood says the use of 3D printing is not yet fully mature and will only continue to grow.
"It is certainly a long way from mature,” says Renishaw. "The manufacturing systems (for medical devices) themselves are certainly evolving at a rapid pace.” But Littlewood says much value resides in designs that use additive manufacturing for jigs, tools and guides to help surgeons.
Precision Knee Replacement
One application is the fabrication of surgical guides based on a patient’s physiology. Suppose a patient is to have a total knee replacement. A guide to aid the complex surgery may be tailor-made based on the unique physiology of the patient’s knee. It helps the surgeon know exactly where to make incisions and how to position components of the knee replacement. It affords a very precise fit and results in a more successful surgical procedure. It enables the patient to not only receive the procedure well, but also recover much quicker than usual.
"Once design tools morph and evolve to encompass additive manufacturing and engineers' understanding grows, then we'll start to see some maturity,” says Littlewood. "For medical applications, additive manufacturing surgical guides have been a massive boost to surgical productivity, helping to save hours in surgery which equates to $1,000s in any healthcare system. ”
Performing Jaw Surgery
Renishaw created surgical guides to help treat a patient who suffered cancer of the lower jaw and required removal of the affected region coupled with reconstructive work. It was a very precise surgery that was greatly expedited with the use of a surgical guide.
The patient, a male in his 60s, was diagnosed with oral cancer and required surgery to remove the left side of his lower jaw. Then this portion of his jaw would need to be reconstructed using fibula bone from one of his legs. To reconstruct the jaw, two sections of fibula bone and tissue were connected to the remaining healthy jaw sections – a challenge for the surgeon.
The lead surgeon needed three cutting and drilling guides and a mandibular plate implant. Using the patient’s CT scan, they were able to import the data into 3D modeling software.
Using the model, a cutting guide was fabricated with 3D printing to help remove two sections of bone and vascular connective tissue with precision. The guides included pilot holes drilled at the exact position on the bone to allow for the final fixation screws to complete the reconstruction. They were then used to help the jaw implant fit perfectly and align properly in its final position.
Guiding Delicate Spinal Surgery
In another case, 3D-printed templates and bone models helped surgeons conduct a critical surgery in a 12-year-old Dutch girl with a rare spinal deformity. The delicate surgery required a multidisciplinary team who needed to accurately plan a procedure prone to very risky complications. Using MRI and CT scans of the patient’s spinal cord, the surgical team created a 3D virtual model of the spine.
Using the model, they printed guiding templates that fit directly onto the bone. These templates helped guide a surgical chisel, making certain the spine maintained the precise position as the deft surgeons cut away pieces of bone.
The cost to produce the template was minimal and took a day to fabricate. In the end, it was a success. Remarkably, the young girl left the hospital eight days after the surgery and the spinal deformity was corrected.
While these are only a few examples of how the medical community is embracing additive manufacturing and 3D printing to make great strides in surgery, we can expect to see more in the future. These examples are emblematic of the smart use of available 3D printing technology to help solve problems and improve human lives, and would not have been possible in the past.
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