3D Printing in Surgery

3D modeling and printing is becoming increasingly popular in the field of medicine such as surgery. Creating visual models that are adapted to the human body allows for personalization of the treatment process for a specific patient. This method is also of great value to doctors, since it is possible to develop models of parts or entire organs, bones, joints, implants, prostheses, and even individual surgical kits.

Created to order by the surgeon, personal surgical kits include instruments and guides manufactured taking into account the anatomical features of a specific patient. Individually selected equipment allows complex operations, such as tumor resections and reconstructions, to be performed with greater precision, preserving healthy tissue, bones, and joints that would once have been destroyed.

3D printing technology, successfully used at Tel Aviv Medical Clinic (TAMC), improves and adapts the surgical plan even before entering the operating room. This reduces the time for decision-making during surgery, reduces the risk of complications, and interventions become shorter, simpler, and less invasive.

Benefits of 3D Printing

• Increased surgical precision.
• Reduced overall patient risks.
• Achieved better surgical results.
• Significantly reduced surgical time.
• Reduced blood loss during surgery.
• Reduced hospitalization time.
• Accelerated rehabilitation.
• Reduced surgery costs.
• Improved communication between doctor and patient.

The use of 3D anatomical models is also of great importance when explaining procedures to patients and their families, which promotes greater understanding and trust.

Applications

• Surgical models. Detailed 3D anatomical color models of organs, bones, joints and other structures.
• Custom surgical instrument kits. 3D printers create and print instruments tailored to the individual needs and characteristics of patients.
• Orthopedic devices. The method allows for the design and printing of customized impressions.
• Surgical implants. Created using innovative materials and structures. 
• Digital imaging. Clear color images are obtained with precise definition of discrete anatomical structures.
• Virtual reality. The doctor has the ability to create a 3D model of the surgical field with highlighted structures to simulate surgical intervention.
• Robotics. 3D technologies are combined with robotic systems.

How does it work?

1. CT/MRI is performed, the images after which are converted into a 3D model.
2. Based on this model, the doctor, using special software, can plan the operation.
3. The team develops instruments for a specific patient, taking into account his anatomical features.
4. Instruments and an anatomical model of the affected area are printed and used directly in the operating room.

Clinical cases

Chondrosarcoma of the lower pelvis 

Patient: male, 63 years old.

Diagnosis: tumor in the lower pelvis.

Treatment: surgical removal of the entire tumor with maximum preservation of healthy bones. Special instructions for the removal of the tumor were developed, as well as a 3D model of the affected area. 

Problem: tumor that has spread to the pubic bone, ischium and acetabulum.

Surgical plan: making one incision through the acetabulum with maximum preservation of healthy bone.

3D modeling: Due to the difficulty of access, three cutting guides were created: anterior, posterior and internal for the acetabulum.

Printed parts:

Added value: The 3D model improved understanding of the structure of the affected area. The use of cutting guides allowed for maximum preservation of healthy bone and increased accuracy of the entire process.

Ewing’s sarcoma of the tibia 

Patient: male, 18 years old.

Diagnosis: malignant tumor of the tibia with spread to the medullary cavity.

Treatment: to avoid amputation, special cutting guides were developed to perform the most accurate resection. A 3D model of the lower limb was also created.

Problem: Ewing’s sarcoma of the tibia with damage to the medullary cavity.

Surgical plan: performing a wide resection of the neoplasm while maintaining the integrity of the bone.

3D modeling: resection plan, cutting guide, cryosurgical container, allograft resection guide.

Printed parts:

Added value: precise resection, preserving the integrity of the bone. Early fusion was achieved after the operation, and the patient eventually returned to light sports.

Osteoblastoclastoma L5 

Patient: Male, 20 years old.

Diagnosis: Recurrent aggressive tumor in the L5 vertebra. 

Treatment: Several printed scaffolds and a spine model were developed, allowing the surgeons to find the best fit and best access. 

Problem: Recurrent aggressive tumor in the L5 vertebra.

Surgical plan: vertebral resection and frame reconstruction.

3D modeling: trial frames of various sizes.

Printed parts:

Additional value: precise adjustment during individual reconstruction of implants. After rehabilitation, the patient has good mobility in the lower back, no pain or neurological symptoms.

Osteosarcoma of the mandible 

Patient: Female, 54 years old.

Diagnosis: Malignant tumor of the mandible.

Treatment: A 3D model of the jaw and two cutting guides were created for precise joint-preserving resection and fixation of the jaw in place for reconstruction.

Problem: Osteosarcoma of the mandible on the right, touching the temporomandibular joint.

Surgical plan: wide resection of the lower jaw with preservation of the temporomandibular joint.

3D modeling: two cutting guides, a model for bending the plate at a right angle, a support for holding the lower jaw.

Printed parts:

Added value: better tumor visualization, increased productivity. The use of cutting devices led to greater precision. As a result, the patient could open his mouth after the operation. There were no problems with eating or pain.

Anatomical model: heart

Task: Simulate right ventricular surgery with double outflow. 

Solution: Based on the results of scanning patients with congenital heart defects, individual 3D models are created to help plan complex surgeries.

Problem: right ventricular double outflow heart defect.

3D modeling: right ventricular double outflow tract defect.

Printed parts:

Added value: 3D models allow the surgeon to tailor the procedure to the specific procedure, reducing operating room time and increasing confidence.