Yale’s First In-House “3D” Surgical Case: A Leap in Medicine

Surgeons at Yale School of Medicine pioneered the first fully in-house 3D surgical procedure to fix a misaligned bone near the wrist. Dr. Lisa Lattanza, Chair and Ensign Professor of Orthopaedics & Rehabilitation, led the surgery, using 3D printed guides and models to plan and execute the operation with high precision. She also collaborated with engineers to customize the surgical approach, reducing surgery time and improving precision and patient recovery.

Lattanza, renowned for her pioneering work, including the world’s first elbow transplant, joined Yale in 2019 with a vision. Her goal was to integrate her expertise in 3D surgical planning with emerging innovations in 3D technology and position Yale as a leader in orthopedic care. This vision has become a reality with the successful repair of a distal radius malunion, a condition where a broken forearm heals incorrectly, causing misalignment and deformity.

Traditional methods rely on the surgeon’s judgment and X-rays, often leading to less precise outcomes. However, by leveraging advanced imaging software and 3D printing, Lattanza and her team were able to develop a highly accurate, personalized surgical plan during the pre-surgery phase.

“Orthopaedic surgery is geared towards functionality and returning patients to normal life, and to that end, ‘one size fits all’ is no longer a phrase that applies to us,” Lattanza said. “Our priority is to fully understand each patient and develop a plan of care based on their specific needs, long-term goals, and achievable outcomes. Since every person has a unique anatomy with individualized motion patterns and functions, as well as unique injuries, 3D surgical procedures are tailored specifically for each patient.”

A Closer Look at the Procedure

The patient who underwent this in-house 3D surgical case had suffered a forearm injury resulting in functional impairment and cosmetic troubles. Traditional osteotomy procedures involve cutting and realigning bones and rely heavily on the surgeon’s experience and X-rays. However, using 3D planning, Lattanza could accurately correct the deformity.

Key to the success was the precise visualization and planning of the surgery.

“Traditional two-dimensional images leave room for interpretation and error. 3D modeling provides a comprehensive understanding of the deformity, allowing for more accurate and effective surgical interventions,” noted Lattanza. “By overlaying the healthy arm’s anatomy onto the surgical side, we can comprehensively analyze and plan the correction. This process involves collaboration between the surgeon and the engineer, ensuring the best possible outcomes.”

A central driver in this development is the 3D Collaborative for Medical Innovation (3DC), based in Yale’s Department of Orthopaedics & Rehabilitation. Directed by 3D Medical Engineer Alyssa Glennon, the 3DC combines engineering expertise and medical innovation to create patient-specific models and tools. Glennon, who spent ten years at Materialise, most recently as a principal engineer, was instrumental in advancing the company’s clinical sector.

During her tenure at Materialise, Glennon collaborated with some of the country’s leading orthopedic surgeons to develop 3D virtual surgical plans and patient-specific instrumentation for complex cases, including the world’s first pediatric bilateral hand transplant and a unique autologous elbow transplant. This extensive experience has paved the way for her success at Yale, where she partners closely with Lattanza to advance personalized orthopedic care.

At Yale, these 3D printed anatomical models and surgical guides provide tactile references for surgeons, improving precision and reducing complications.

“Our objective is to integrate engineering expertise into surgical planning,” Glennon stated. “We bring technology like 3D printing, artificial intelligence, and virtual reality into the operating room, supporting our clinicians in delivering optimal care.”

Real-Time Collaboration

One significant advantage of having an in-house 3D lab is the ability to make quick adjustments based on real-time feedback. Such closeness to the operating rooms and clinicians allows quicker turnaround times and better communication. Glennon explains that with the 3DC located within Yale School of Medicine, engineers can support a wider range of pathologies and patient demographics. Even more importantly, the 3DC can even have engineering staff present during the surgeries, ensuring immediate support and adjustments if needed.

However, the applications of 3D technology extend beyond orthopedics at Yale. The 3DC’s engineering services include medical imaging data segmentation and 3D digital model creation. Capabilities that open doors for collaboration across various medical disciplines. Moreover, in 2022, the institution launched the nation’s first master’s degree in personalized medicine and applied engineering. This program, developed by Lattanza, Glennon, and their colleagues, trains the next generation of medical and engineering professionals in 3D technology and personalized patient care.

“This technology is transforming how we approach medical education and research,” Lattanza emphasized. “By understanding three-dimensional anatomy, we can develop better surgical techniques and improve clinical outcomes.”

Leap in Surgical Planning

Over the last decade, many surgeons have spearheaded 3D printing in surgical preparation, proving its transformative potential in patient care. Leading institutions such as the Mayo Clinic, University Hospitals Cleveland Medical Center, UCLA Health, and Salzburg University Hospital have been at the forefront of this innovation.

At Mayo Clinic, 3D printing creates life-size anatomical models from patient scans, enhancing surgical precision and reducing operation times. UCLA Health uses 3D heart models for safer and more efficient surgeries, while institutions like the University of Florida Health have been leveraging 3D printing for talus bone replacements, allowing for customized implants that fit patients’ unique anatomies and enhance recovery. In Europe, Salzburg University Hospital employs custom 3D-printed cranial implants to improve surgical outcomes.

Lattanza’s work at Yale School of Medicine is yet another magnificent example of this innovative approach, which is setting a new standard for personalized patient care. This level of customization in surgery ensures better bone alignment, shorter recovery times, and overall enhanced patient experiences.

“Orthopaedic surgery aims to restore functionality and normal life. Each patient’s unique anatomy and injury require tailored approaches and 3D surgical procedures allow us to meet these specific needs,” remarked Lattanza.

As the technology continues to evolve, the adoption of 3D printing in surgical preparation is expected to grow, offering even more precise, efficient, and personalized medical care.

All images courtesy of Yale School of Medicine.