AMS Spring 2023

Duke Embracing 3D Printing for Surgical Care

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There is practically no area of medical practice that has not been impacted by advances in 3D printing technologies. Whether in the form of custom made prosthetics, the development of specialized tools, or the creation of medical models to prepare future surgeons for practice, the contributions made by 3D printing are undeniable. And the staff at Duke University School of Medicine have fully embraced the potential the advanced technology offers.

Duke is recognized as one of the top medical institutions in the United States and they have the opportunity to work with some of the most complicated medical interventions as a result. Recently, they worked with a young woman who had a chronic limp as the result of a hip malformation. In order to address the problem, the medical team decided that the best place to start was to take the data collected about her anatomy through MRI and CT scans and convert it into a life-size 3D printed model that they could examine and manipulate.

The model itself was fabricated on-site in the campus Co-Lab Studio, a 2,000-square-foot space dedicated to the tools of advanced manufacturing and housing more than five dozen 3D printers. Having the facilities so close on hand reduces both the amount of time required to get such a model and the costs associated with it. Having the opportunity to examine the 3D model before undertaking the surgery alerted the medical team to damage that had occurred in her hip due to the grinding in the malformed area. As a result, instead of the originally conceived intervention of reconstructing the damaged joint, they opted to replace the hip instead. This enhanced preparation is something which Dr. Robert Kollmorgen, 2016-2017 hip preservation fellow at Duke, recognized as resulting from the 3D printed model:

“The best thing we can do for our patients is think before we cut. The 3D printed model allowed us to be better planners up front and map out what we feel is the best surgery we could offer her.”

This replica of a calcified heart valve was created using one of Duke’s newest 3-D printers. Soft tissues were printed using a flexible material, and calcium deposits were printed using a more rigid material.

In another area of the massive teaching hospital, general surgery resident Dr. Alice Wang worked with Dr. Sreekanth Vemulapalli to 3D print a model of the flexible anatomy of the aorta as they attempt to minimize the potential for complications associated with a common heart procedure designed to correct aortic stenosis. This condition occurs when the aortic valve loses its flexibility and is prevented from opening as it should, thereby constricting the flow of blood.

This condition, which affects many thousands of older Americans each year is generally addressed by inserting a new valve. The replacement valve is folded up and placed into a small tube which is then inserted into a blood vessel and guided into place where it is opened outward. The difficulty is that sometimes these replacement valves don’t fit perfectly and can leak, and the hope held by Wang and Vemulapalli is that through testing 3D printed models beforehand, in order to predict which patients were more likely to experience leaks. Once they understand that, they can then plan carefully the exact procedure necessary in order to reduce the possibility of such a leak occurring. The benefits are immediate, as Wang explained, “This really allows us to guide our treatment for each individual patient and personalize their experience.”

The procedure, transcatheter aortic valve replacement, has demonstrated great benefit from 3D printing technologies, as showcased at Duke as well as Georgia Tech and being explored at the Ohio State University, while at Henry Ford Hospital System the team uses 3D printed heart models similarly in transcatheter mitral valve replacement and repair procedures.

Dr. Alice Wang shows off a 3-D printed heart valve. The valve is one of several personalized patient models she has made using Duke’s dedicated 3-D printing studio. [Photo: Jeannine Sato]

The expansion of materials that can be 3D printed, along with the precision with which 3D prints can be realized, has continued to increase the uses for the technology in every aspect of medicine from early education to research to the interventions themselves. It has been consistently demonstrated that preparing students and experts alike helps to improve the outcomes of surgeries whether because of the practice provided, the customization of the parts needed, or the simple reduction of time during which the patient is in surgery. The impacts are enormous, as Supervisor of Duke’s Multi-Dimensional Processing Lab Susan A. Whitney, BSRT, described:

“All the scans are tailored to the patient, but then we take that scan another step further, have a virtual model, and then have a 3D printed physical model. I guess I like to think about it as: every body has a story, and we try to help illustrate that.”

It’s the tremendous support provided by 3D printing in the creation of personalized, patient-based solutions that sets this technology above and beyond all others, and Duke has embraced this new technology as part of its own new normal.

What do you think of this news? Let us know your thoughts; join the discussion of this and other 3D printing topics at 3DPrintBoard.com.

[Source/Images: Duke]

 

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