Carsten Engel – Biomedical engineer: 3D printing is not a dream. It is not a toy. It hasn’t been invented two weeks ago. In fact, it is already a production technology. 3D printing has a big impact on a lot of markets, especially for the medical sector. Can 3D printing really be the rebirth of current medical practice? Medical practice has changed a lot over the years. Let me show this to you.
This is a picture of how an operating theater looked like 100 years ago. Exactly 100 years ago. What you can see on this picture is that the surgeons are operating on the patient amongst the classroom with all the students. What you can notice as well is that nobody is wearing a mask or wearing gloves. So it’s not a very sterile environment such as we would know it today.
What we can notice as well is that there is very few, nearly no technology involved at all. This is how an operating theater actually looks like today. It’s a picture that I took from Google. It’s a German operating theater. And what we can see there is that today there is a lot of technology involved.
If you’ve been there already, for your work or as a patient yourself, you would have noticed that there’s a limited amount of staff: one, maximum two surgeons, an anesthesiologist, a couple of nurses, maximum two. Maybe a technician but that’s it. Maybe an intern, of course. There are nearly more screens than medical staff today. Over the years, new technology has been introduced to operating theaters and in medical practice.
Surgeons and doctors have always been very careful about introducing new technology. And with 3D printing, a lot is happening. We will see this together during my presentation. The future might look like this. What you can see on this picture, would be one surgeon with his patient, no other staff, and one 3D printer.
What you can see as well is there’s something happening with the 3D printer. It’s a bit like your home printer or your paper printer, when there are two papers being printed at once or missing ink, for example. You know this as well. With this organ or 3D bio-printer, there is an issue, a technical problem. A lot of organs are coming out of this printer while the surgeon wanted only one. This might be what the future will look like.
What is 3D printing? Let me explain this to you a bit. 3D printing is a process, a technology, where a 3D file is first sliced into a thousand, a couple of thousands, even tens of thousand of 2D slices. They are interpreted by the technology itself, and reproduced layer by layer. We can use ceramics, metals, and polymers, all kinds of materials, to recreate a highly complex object.
In fact, it is that complex that we can customize a product entirely. And for the medical practice, this has a huge impact: being able to customize a product gives you the possibly to create something that is patient-specific. One example in the current practice today: did you know that the hearing aids produced today, 96% worldwide of those hearing aids are produced by 3D printing? This represents yearly about more than 10 million parts produced on those technologies. You can already think of this technology as a real production technology. This is how it looks like.
This is one of the hearing aids as it is printed today. The material here is a liquid resin. It has to be cleaned afterwards, and a couple of support tractors have to be removed. Then, it’s transferred to the specialist who use it for their own patients, so there is a little marking as well on the product. It’s patient-specific.
If you look at the people sitting next to you on your left, on your right, you notice that we’re all different, we are all individuals – except if we are perfect twins, of course, then the anatomy of our skulls would be the same – but in most cases, that’s not the case. This product, the hearing aid, is custom-produced for your ear.
Another example: 3D printing has enabled the reduction of surgery time for the medical practice. One powerful example is that. In the past, in 2001 and 2002, – it’s not a technology invented two weeks ago – surgery time has been reduced from 97 to 23 hours. This is amazing. Let’s have a look at this case study.
Those little Siamese twins are bound to one another by their skull. Of course we would like to separate them to give them a healthier life, and maintain them alive. As you might imagine, this is a highly complex procedure. Such a procedure is very rare. It doesn’t happen and occur very often.
When surgeons are confronted to such cases, they have to either improvise or work 97 hours straight in order to bring a solution to this case. 3D printing helped reducing surgery time to bring an easier solution for the surgery. As you can see, the problem here was not only that their skull was bound together, but the veins bringing the blood were merged together too. In order to separate them, surgeons had to decide what tools to use, where and how to cut. Being able to rehearse the procedure before the operation, this was a real game changer for this case study.
This is an example of what has been 3D printed. It’s a patient model of the skull. You see that there are three different colors. The translucent and white one are the skull, the anatomy. The blood vessels are represented in red. This model enabled the surgeons to rehearse the operation before the surgical act, reducing the time from 97 hours to 23 hours. Imagine working 97 hours straight, with the same concentration you would have from the first minute to the last minute. So this is actually amazing. 3D printing may bring a solution when there is no other solution, especially in the medical field. For this case study, this was a very old patient and she had bone cancer on the jaw.
The surgeon came to the conclusion that the current technologies and practice was not bringing any solution to help his patient. What we did is to recreate an entire jaw in order to provide a solution for the surgeon. As you can see, it’s patient-specific. That’s one thing. It also matches exactly the functions and the weight of the previous jaw, the bone.
This one has been printed in titanium. So, how does it work? This is a video showing how the patient is inserted in a PET/CT scanner. From the CT scanner you obtain 2D files of the skull and soft tissue. You can retrieve from that information the skull structure, the bone recreate a 3D file progressively, and then have it printed either for rehearse function like this skull, which is in polymer, or print the patient-specific implant. And you can scale it up or down, you can have markings on it, or you can cut it as well to have only a portion of it.
So this is very interesting for the surgeons. Another application: this is exactly what we did on this one. This is a skull printed from a patient who has suffered from a bike accident. No helmet. Think about this. The solution, as you can see, is that it is highly complex to produce an implant that is patient-specific. With this technology, 3D printing enables – actually this is a PEEK implant – to provide a solution that is patient-specific and that fits perfectly.
Another thing is that 3D printing is actually saving lives. For this case study, this was done in Michigan on this little boy, 20 months old. His problem was his bronchus. He suffered from a rare disease. His bronchus wouldn’t stop collapsing. Basically, he couldn’t breath. This was happening again and again. Doctors actually thought he wouldn’t come out of the hospital.
What 3D printing could do for this little boy was to provide an implant that matches exactly the anatomy of this bronchus. It’s a splint that has been produced in a biodegradable material. This implant was put on the patient, on this little baby here, and will disappear progressively in time, saving the life of this baby. This is where we’re heading for. We can print today with metals, ceramics, polymers, biodegradable materials.
3D printing technology, it is a tool, a powerful tool. It enables surgeons to rehearse, to pick the correct instruments, the correct way and procedure to operate on the patient, save lives, bring a solution when there is no other solution. But it can go a bit further. Currently, researchers are working on bio-printing, as it’s called, or organ printing. The idea is to use the patient’s own stem cells, to combine them with growth factors, and construct them, for example, on a biodegradable polymeric scaffold in order to recreate organs.
One of the first pictures I showed before, is this idea: progressively introducing bio printing and organ printing for the medical practice. This is good news for big smokers or heavy drinkers. They could endlessly drink and smoke, do both together, without thinking about the consequences, and live on and on for 200 years. Is this the idea we want to promote about technology and the medical practice? Or shall we use it for specific cases such as the case of the little baby? When, where, with what technology and what materials? The real question with this technology especially, would be actually how far can we go? Thank you.