Conquering an 18-Hour Surgery: When 3D Printing Meets Pediatric Medicine

In the realm of healthcare, innovative technology continues to redefine possibilities, offering new approaches to diagnose, treat, and manage health conditions. A recent case from Children’s Hospital and Medical Center in Omaha, Nebraska, showcases how pediatric surgeons turned to 3D printing and virtual reality (VR) to master a complex, life-saving surgery.

For eighteen-year-old Karys Kouba, a stomach pain she thought was appendicitis quickly turned into a different diagnosis after a CT scan unveiled a more severe issue: a benign tumor called ganglioneuroma. Although benign, the tumor’s critical location – wrapped around her aorta, pressing against her spine, and tangled with blood vessels – presented an overwhelming challenge for the medical team. The tumor was in such a dangerous place that it affected not only the blood vessels to the body but also those delivering blood to the bowel, and it even impacted the kidneys.

This alarming medical scenario required a team of experts led by Patrick Thomas, the center’s Director of Digital Innovation in Pediatric Surgery, who decided to bring technology into the mix. By partnering with the Children’s Innovation Team, the surgeons could create a detailed 3D printed model of Kouba’s midsection using a Stratasys J850 digital anatomy printer. This model allowed them to visualize the tumor’s situation more effectively, aiding with their surgical planning. Then Thomas went one step further by creating a virtual reality landscape of Kouba’s abdomen.

As Abdulla Zarroug, Division Chief of Pediatric Surgery, pointed out, “As far as I know, even in the Midwest, no one has done that—at least an application in real life.”

With this VR backdrop, physicians could have a sub-centimeter-level understanding of Kouba’s tumor, allowing the team to virtually navigate the anatomical environment they would soon face during the surgery.

“You’re actually able to walk around in the anatomical environment and turn yourself into a little robot or surgeon,” Thomas said.

In February 2023, after meticulous planning and preparation, the surgical team at the Children’s Hospital and Medical Center performed an 18-hour procedure to remove Kouba’s tumor. The operation’s complexity demanded a multi-disciplinary approach, with specialists from the center’s general surgery, neurosurgery, urology, and cardiothoracic surgery collaborating closely, leading Thomas to compare the experience to a “symphony.”

“Everyone has mastery in their area, but then you all come together, and you are able to perform a beautiful masterpiece,” he explained.

The surgery proved successful, with Kouba moving on to a healthy future, made possible by the medical team’s collaborative efforts and technological innovation.

Kouba’s mother was thankful to the medical team and dedicated these words to them: “Dr. Zarroug and Dr. Thomas have been amazing, compassionate people. I felt very comfortable coming here and putting my daughter’s life in their hands because I knew that they were the best.”

Children’s Hospital and Medical Center began using 3D models in 2016 after cardiologists saw a need for them in the pre-operative planning and treatment of congenital heart defects. Since then, the Radiology Department has created over 100 3D models.

“It’s much easier to show families a model and explain what you’re going to do rather than show a scan, which is a kind of abstract art,” explains Lincoln M. Wong, a radiologist in the renowned children’s hospital.

Wong says many of the 3D models created at the center are for tumors. To decide which cases are optimal for 3D models, physicians and radiologists work together. Once they decide that a case will benefit from 3D printing, the Radiology Department prints the tumor along with surrounding other organs and vessels. that will be involved in the surgery (just like they did for Kouba).

The 3D printing process can take between three and five days, and once it’s printed, doctors use it for surgical planning and teaching, while some even bring it into the operating room with them.

“I have heard of cases that should have taken six hours but that we’ve completed in three hours because the surgeon can operate so much faster with the model in sight,” suggests Gabe Linke, a 3D Lab program manager that works on creating the models with Wong.

As we usually see with groundbreaking and successful cases that merge medicine and technology, Kouba’s case marks a breakthrough in using high-tech solutions like 3D printing and VR in surgical preparation and planning. It paves the way for future innovations and applications, demonstrating that technology can be the key to overcoming even the most complex medical challenges.