Stratasys advanced FDM 3D printing helps Biodonostia to improve treatment for thoracic wall tumors

Executive Summary:

Founded in 2008, the Biodonostia Health Research Institute was the first institute for medical research in the Basque region of Spain. Facing difficult surgical challenges every day, it recently partnered with Tknika, a Research and Applied Innovation Centre for Vocational Education and Training in the Basque region, and Tecnun, a specialist division of Universidad de Navarra, to enable surgeons to harness the latest 3D printing technology as a tool to aid surgical preparedness. Now, using Stratasys advanced FDM 3D printing technology, the hospital can create advanced, patient-specific 3D printed models to plan for complex cases such as complicated thoracic wall tumors. The partnership allows them to convert the CT scan of the patient into a 3D printed model and deliver it to the surgical team within 24 hours. Due to these models, the team are now enjoying a reduction in surgical time, avoidance of lengthy, invasive surgical procedures and improved patient care.

Patient-specific 3D-printed model of a tumor on the thoracic wall. 3D printed using the Stratasys Fortus 450 mc.

Benefits/Value:

• Using precision 3D printing, surgeons at Biodonostia are able to create highly-accurate patient-specific 3D models to plan for thoracic wall tumor surgeries.
• Surgical time for the removal of a complicated thoracic wall tumor in a 64-year-old patient reduced by 2 hours due to the ability to plan the surgery in advance with a patient-specific 3D printed model.
• Surgeons are now able to reduce often lengthy and invasive steps by measuring the necessary screws and pre-bending the titanium plates accurately before the surgery using the patient-specific, accurate 3D printed model.
• Biodonostia is now working with 23 hospitals across Spain, providing them with access to advanced Stratasys 3D printing technology to enhance pre-surgical planning and improve patient care.

Biodonostia Health Research Institute, founded in 2008, is the first institute for medical research in the Basque region of Spain. Today it undertakes research in seven subject areas that bring together over 350 researchers across 26 groups. Daily, the institute, and the co-located Donostia University Hospital where all treatment takes place, face challenging surgical cases. These all require precise, complex and often difficult surgeries during which surgeons need to make the most of every tool in their arsenal to ensure a safe clinical outcome.

A new, and vital tool is 3D printing. The hospital recently entered into a partnership with Tknika, a Research and Applied Innovation Centre for Vocation Education and Training in the Basque region, and Tecnun, a specialist division of Universidad de Navarra, providing the surgical team with access to more advanced 3D printing technology.

3D printing is an essential surgical tool for us. Previously, no 3D printed model we created in-house could meet the level of detail and accuracy we needed. However, thanks to our partnership with these local institutions, we now have access to advanced 3D printing technology from Stratasys that enables us to meet the demands required to create highly-accurate, patient-specific 3D models.”

Dr  Jon Zabaleta, Thoracic Surgeon at Biodonostia

Stratasys FDM 3D printing has proved particularly important when treating complex, and often life-threatening thoracic wall tumors. Located on the chest wall, thoracic tumors can cause excessive and painful swelling, or lead to breathing trouble for the patient.

Surgical Time Reduced by Two Hours

In a recent case, a 64-year-old man came to Dr Zabaleta and his team with an extremely complicated tumor on his thoracic wall. Over the course of two years, the tumor had slowly grown up his chest cavity and spread across multiple ribs. The man was in intense pain, with surgeons concerned about his respiratory function.

Ordinarily, in a case like this, we would remove the affected ribs and correct the defect by covering the area with a titanium plate. These plates are a standard size, designed for men of 100 KG or women of 50 KG, and need to be altered and rotated during surgery to suit each patient specification. In a complicated surgery, this can add hours to the operating time.”

Dr  Jon Zabaleta, Thoracic Surgeon at Biodonostia

As Dr Zabaleta explains, this case presented a complex challenge for the surgical team, as removing the tumor would require removal of more than one rib, an unusual method of treatment that increased the risks associated with the surgery. As a result, the surgeons needed to find the best way to correct the defect with the strength to protect the lungs, while maintaining flexibility and movement in the chest.

In order to explore and plan the surgery, the surgeons turned to their partnership with Tknika and Tecnun to produce an advanced, patient-specific 3D model of the patient’s thoracic wall on the Stratasys Fortus 450 mc 3D Printer. Together, the hospital’s partners converted a conventional CT scan of the patient into a 3D printed model and return edit to the surgical team within 24 hours.

By creating a precise, anatomically-accurate 3D printed model of the thoracic wall, we were able to plan and perform the resection on the 3D model ahead of the surgery. This allowed us to measure the screws and pre-bend the titanium plates in advance and helped reduce the overall operating time by 2 hours. For the patient, this meant a significant reduction in time under anesthesia, and for our hospital, freeing up time in operating rooms saves costs.”

Dr Jon Zabaleta, Thoracic Surgeon, Biodonostia Health Research Institute

For this thoracic wall tumor, the surgeons required a model strong enough to replicate human bone, so the teams at Tknika and Tecnun selected Stratasys FDM technology thanks to the ability to print in engineering-grade thermoplastics.

“Our partnership afforded us access to the necessary technology to produce a large and complex model that was incredibly strong, close to the real bones we would face during surgery. Without the strength of this model, we could not have prepared for the surgery in the same way,” explains Dr Zabaleta.

In addition, Dr Zabaleta credits an improvement in patient-doctor communication to the 3D models. For the man in the aforementioned case, the ability to use 3D printed models to explain how they intended to protect his lungs helped to alleviate his anxiety ahead of a complicated operation and enables informed consent to be achieved quicker and more easily. Additionally, the surgical consult is faster and more efficient, offering the surgeon time to see more patients

Extending the use of 3D printing to other disciplines

Dr. Zabaleta believes that the next natural step will be for all surgical disciplines at Biodonostia to use Stratasys 3D printing to prepare and plan for surgeries, as it offers the hospital the opportunity to innovate their treatment procedures and improve patient care.

“The use of the 3D printed model was so essential to this case, and we are working to apply this to many other surgical disciplines across the hospital, from pancreatic tumors to airway stenosis,and these 3D printed models are already being used to help train our future surgeons,”explains Dr.Zabaleta.

Ultimately, the goal of the partnership with Tknika and Tecnun is to create a multi-disciplinary team that collaborates to create the best possible 3D printed surgical models for the hospital on-demand, with Tecnun’s involvement centering around the segmentation and reconstruction of the models, and Tknika producing the final 3D printed versions. But this collaboration is not just limited to Biodonostia, as the hospital is currently working to provide 3D printed models to 23 other hospitals across Spain.

“We’re thankful to have such knowledgeable partners in Tknika and Tecnun. Coupled with the dedicated local support of Stratasys distributor, Pixel Sistemas, we’re confident that the hospital can continue to help patients with access to the most advanced 3D printing solutions,” concludes Dr Zabaleta.