3D printed models for kids’ operations

http://www.engadget.com/2015/08/01/boston-childrens-hospital-3d-printing/

Surgeons practice on 3D-printed models for kids’ operations

Surgeons at Boston Children’s Hospital started using 3D-printed copies of patients’ affected body parts to prepare for procedures last year. Now, that move has helped save the lives of four children aged two months to 16 years old who suffered from life-threatening blood vessel malformation in their brains. Their condition gave ride to distinctive anatomies that one of the hospital’s neurosurgeon, Edward Smith, said were really tricky to operate on. So, the doctors used a combination of 3D printing and synthetic resins to conjure up copies of the kids’ deformed vessels, along with nearby normal counterparts and surrounding brain anatomy. That gave them the chance to practice extensively beforehand and reduce possible complications on the operating table.

Smith said the models allowed them to “view [the formations] from different angles, practice the operation with real instruments and get tactile feedback.” It was especially beneficial for three of the four patients, as they had arteriovenous malformations (AVMs) — their arteries and veins were all tangled up – that required the surgeons to cut blood vessels as quickly as possible, and in a certain sequence. Thanks to their preparations, the surgeons managed to fix the kids’ distorted blood vessels and cut surgery time by 30 minutes each. Smith and his colleague Darren Orbach now plan to use 3D printing to train younger doctors and for even trickier cases in the future.

engadget.com

by Mariella Moon | August 1st 2015 At 3:33am

Advertisements

Separated of twins, joined at the butt thanks to 3D printing technology

http://3dprint.com/71548/conjoined-twins-butt-3d-print/

twins2

Twins, Joined at the Butt, Will be Separated Tomorrow Thanks to 3D Printing Technology

3D printing has been used to change the lives of many people over the past several years. Whether it is for lending a hand in the rapid prototyping of products, creating prosthetic hands for children with upper arm differences, or allowing surgeons to perform high risk surgeries with much more ease than ever before, the technology is certainly providing ample benefit to society.

Back in February, we reported on a complex surgery that was undertaken in Texas to separate conjoined twins. To complete the surgery, a detailed medical model was created to aid surgeons in the delicate operation. Now doctors in China are doing the same.

twins3

Tomorrow (June 9), will be a huge day for one family in China, as their beautiful newborn conjoined twin girls will be separated from each other for the first time in their lives. Born on March 17 in Nanjing County of South Fujian, China, the twins were found to be conjoined at the buttocks area. In fact, they share part of the same digestive tract and portions of their anus. Like most surgeries which involve the separation of conjoined twins, it is an extremely risky and difficult operation.

The girls have been transferred to the Children’s Hospital of Fudan University, where the surgery will take place tomorrow. Surgeons opted to wait until the girls were 3 months old and weighed approximately 10kg in order to perform the risky surgery. In studies, this has been shown to be the best time to perform such an invasive procedure, as babies tend to be strong enough at this point, and their bodies are ready to heal on their own.

These twins are in good hands though, as in the past 15 years, the Children’s Hospital of Fudan University has successfully separated 7 sets of conjoined twins. On top of this, using CT scan data, the surgeons were able to create an accurate 3D printed replica of the twins which doctors were able to simulate surgery on. They have used this 3D printed model to perform a mock operation, and in the process were able to revise their “real” surgical plan to make it more efficient and safe. While it is the very first time that 3D printing was used in order to aid in the separation of twins at this hospital, the hospital has used 3D printing in the past for other surgeries.

The surgery will include the separation of the twins, as well as reconstruction of their perineums and the rectums.  Currently the twins share a little less than 1cm of the same anus. It will certainly be a difficult surgery, but with the help of 3D printing, the surgical team feels very confident.

As far as the cost of the surgery, it is very expensive, but the family got a helping hand from the “Angel Mother” charity, in the amount of 200,000 yuan (approximately $32,231).

twins1

Best of luck to these beautiful twin girls as they undergo quite an extensive surgery tomorrow. What do you think about the use of 3D printing in creating medical models for complicated surgeries like this? Discuss in the Conjoined Twins forum thread on 3DPB.com.

3dprint.com

by  | JUNE 8, 2015

3D printing skin!

http://www.bbc.com/news/technology-32795169

Skin

L’Oreal to start 3D printing skin

French cosmetics firm L’Oreal is teaming up with bio-engineering start-up Organovo to 3D-print human skin.

It said the printed skin would be used in product tests.

Organovo has already made headlines with claims that it can 3D-print a human liver but this is its first tie-up with the cosmetics industry.

Experts said the science might be legitimate but questioned why a beauty firm would want to print skin.

L’Oreal currently grows skin samples from tissues donated by plastic surgery patients. It produces more than 100,000, 0.5 sq cm skin samples per year and grows nine varieties across all ages and ethnicities.

Its statement explaining the advantage of printing skin, offered little detail: “Our partnership will not only bring about new advanced in vitro methods for evaluating product safety and performance, but the potential for where this new field of technology and research can take us is boundless.”

A scientist with skin cells

It also gave no timeframe for when printed samples would be available, saying it was in “early stage research”.

Experts were divided about the plans.

“I think the science behind it – using 3D printing methods with human cells – sounds plausible,” said Adam Friedmann, a consultant dermatologist at the Harley Street dermatology clinic.

“I can understand why you would do it for severe burns or trauma but I have no idea what the cosmetic industry will do with it,” he added.

3D-printed livers

The Wake Forest Institute for Regenerative Medicine has pioneered the field of laboratory-grown and printed organs.

It prints human cells in hydrogel-based scaffolds. The lab-engineered organs are placed on a 2in (5cm) chip and linked together with a blood substitute which keeps the cells alive.

Organovo uses a slightly different method, which allows for the direct assembly of 3D tissues without the need for a scaffold.

It is one of the first companies to offer commercially available 3D-printed human organs.

Last year, it announced that its 3D-printed liver tissue was commercially available, although some experts were cautious about what it had achieved.

“It was unclear how liver-like the liver structures were,” said Alan Faulkner-Jones, a bioengineering research scientist at Heriot Watt university.

Printing skin could be a different proposition, he thinks.

“Skin is quite easy to print because it is a layered structure,” he told the BBC.

“The advantages for the cosmetics industry would be that it doesn’t have to test products on animals and will get a better response from human skin.”

But printed skin has more value in a medical scenario, he thinks.

“It would be a great thing to have stores of spare skins for burn victims.”

References:

bbc.com

http://www.bbc.com/news/technology-32795169

3D printing impact on human life

http://www.cbsnews.com/news/meet-3-kids-alive-today-thanks-to-a-3d-printer/

kaiba-heart-kid-620x750-90746.jpg

Meet 3 kids alive today thanks to a 3D printer

A 3D printer saved the lives of three baby boys with the same life-threatening condition, their doctors report in the latest issue of Science Translational Medicine.

Kaiba Gionfriddo was six weeks old when he turned blue because his lungs weren’t getting enough oxygen. He was diagnosed with a terminal form of tracheobronchomalacia, a medical condition that causes the windpipe to periodically collapse and prevents normal breathing. With no cure and a low life expectancy, doctors told his mother April he may not make it out of the hospital alive.

Kaiba was one of the three babies who became the first in the world to receive 3D-printed devices that helped keep their airways open so they could breathe properly, thus saving their lives. “These cases broke new ground for us because we were able to use 3D printing to design a device that successfully restored patients’ breathing through a procedure that had never been done before,” Glenn Green, MD, an associate professor of pediatric otolaryngology at the University of Michigan’s C.S. Mott Children’s Hospital, said in a statement.

Tracheobronchomalacia affects about 1 in 2,000 children around the world, according to the doctors, and renders them unable to fully exhale. Using a 3D printer, Green and his colleagues were able to create and implant a customized splint around the airways of the three boys to expand the trachea and bronchus. This 3D printed device is made to change shape over time as the children grow, and eventually be reabsorbed by the body as the condition is cured.

The findings in the report suggest that this early intervention may prevent complications of conventional treatment of tracheobronchomalacia such as a tracheostomy, prolonged hospitalization, mechanical ventilation, cardiac and respiratory arrest, food malabsorption and discomfort.

Kaiba was the first to receive the implant three years ago and his doctors report that the splint has degraded and he appears to be disease-free. “Before this procedure, babies with severe tracheobronchomalacia had little chance of surviving,” Green said. “Today, our first patient Kaiba is an active, healthy 3-year-old in preschool with a bright future. The device worked better than we could have ever imagined.”

garrett-small.jpg

Two other children have also had success with the device.

Garrett Peterson received one a the age of 16 months. Garrett spent the first year of his life in hospital beds tethered to a ventilator, being fed through his veins because his body was too sick to absorb food.

Since receiving the device, he has not shown signs of any complications and is leading a normal life, able to breathe properly, doctors say.

Ian Orbich’s condition was so grave that his heart stopped before he was even six months old. He received a customized 3D-printed splint and is now doing well at the age of 17 months.

Green and his colleagues received emergency clearance from the FDA to do the procedures. While these three cases appear to be a huge success, the doctors noted that this technology will take time to put into widespread practice. “The potential of 3D-printed medical devices to improve outcomes for patients is clear, but we need more data to implement this procedure in medical practice,” Green said. The authors also acknowledge that potential complications of the procedure may not yet be evident.

Yet if you ask Kaiba’s mom, April Gionfriddo, the procedure was nothing short of a miracle. “The first time he was hospitalized, doctors told us he may not make it out,” she said in a statement. “It was scary knowing he was the first child to ever have this procedure, but it was our only choice and it saved his life.”

cbsnews.com

by ASHLEY WELCH, CBS NEWS | April 29, 2015, 2:05 PM

New face for a girl thanks of 3D printing

http://www.cbc.ca/news/health/3d-printing-helps-give-girl-a-new-face-1.3014957

Violet Pietrok, playing with her father Matt, was born two years ago with a Tessier cleft, a rare deformity in which the bones that form the face have not fused properly. Thanks to 3D printing of models of her skull, Violet has begun a series of surgeries to correct the problem.

3D printing helps give girl a new face

Doctors practise on an exact image of face before repairing deformity.

The great thing about medical school cadavers is that they can’t die.

If a surgeon in training makes a mistake, there’s always next time. It is the last environment where medical errors have no consequences.

But 3D printing is changing that, giving even experienced operating room teams valuable practice on a model that looks and feels like the real thing. It has life-saving and life-altering implications.

Violet Pietrok was born two years ago with a rare deformity called a Tessier cleft. The bones that normally join to form the fetal face had not fused properly.

  • Watch David Common’s full story on The National Sunday April 5 at 9 p.m.

As a result, Violet’s eyes were set so far apart, her vision was more like a bird’s than a human’s. She also had no cartilage in her nose.

But the corrective operation is extraordinarily complex. So Violet’s family turned to one of the world’s leading reconstructive surgeons, Dr. John Meara, at Boston Children’s Hospital.

Violet Pietrok

He warned them of the danger of making sophisticated cuts through the skull, very close to the optic nerve. “They might be very close to the brain,” Meara explained in an interview. “So the ability to make these cuts on the model first and see the trajectory of a sawblade or where that cut would come through in relationship to the eye is absolutely critical.”

To get that model, the simulation team at Boston Children’s took multiple MRIs of Violet’s skull and replicated it on a 3D printer.

It took more than a day to print, but the model is exact. Even the density of the bone is precise.

 “We were actually able to do the procedure before going into the operating room,” Meara said.

“So we made the cuts in the model, made the bony movements that we would be making in Violet’s case and we identified some issues that we modified prior to going into the operating room, which saves time and means that you’re not making some of these critical decisions in the operating room.”

During the surgery earlier this year, Meara kept a model of Violet’s skull close by and referred to it as he went through the complicated steps of the operation. This successful surgery was just the first of several that will be needed to remake Violet’s face.

Other hospitals are interested

Boston’s success has prompted a lot of calls from hospitals around the world looking to set up their own 3D printing simulations to Dr. PeterWeinstock, who runs the Boston program.

He equates medicine with sports teams. Any team worth its salt, he says, practises before the game.

“We looked at that and thought, why is health care not doing that?  If you can see the patient before you see the patient, if you can do the operation before you do the operation, you have the opportunity to tailor your approach, to tailor your team to the specific environment and event. Think about that opportunity.”

Weinstock’s printer now runs 24/7 preparing for procedures at Boston Children’s — well worth the $400,000 investment.

The models are game-changing — giving a whole new meaning to personalized medicine. With each new print, the models are getting more sophisticated. Soon, the replicated veins and arteries will bleed as they would in real-life.

Boston Children’s has also found better recovery times. Patients of surgeons who’ve practised on the models typically leave hospital sooner and get back on their feet more easily.

Weinstock’s simulation program really took off a few years ago with Surgical Sam, the world’s first operable infant mannequin.

A model of an individual

But Weinstock wanted not just a model of generic human but one of a specific person.

That’s also what Adam Stedman needed. Adam was born witharteriovenous malformation or AVM, a tangled mess of arteries and veins in the brain that restricts blood flow and prompts progressively worse seizures that can cause brain damage.

He could have had a stroke at any moment, or a hemorrhage, his mother Amy tearily explained. But surgically tackling the web of tubes inside Adam’s brain was also potentially deadly, or it could leave him blind.

The 3D printer re-created Adam’s brain — including the AVM — something his surgeon could hold, manipulate, examine, re-examine and ultimately, practice on.

The surgery was a success — taking only a third of the expected time because the entire operating room team had done it before just hours earlier on the practice model.

When Adam came out of the OR, he smiled and his mother broke down. “He just has a blind spot,” she said in an interview in her Connecticut home. To her, that’s a big improvement.

“I honestly think that the 3D printing has the majority to do with that, as far as where they knew, where to cut and where not to.”

cbc.ca

by David Common, CBC News | Apr 04, 2015 5:00 AM ET

3D printing and medicine – ethical debate

An Interesting Ethical Debate About 3D Prinnting and Medicine.

http://www.abc.net.au/science/articles/2015/…/11/4161675.htm

3D printed titanium heel

3D printing can offer great benefits in medicine, but it also raises a number of ethical questions as the technology develops, says Susan Dodds.

Three-dimensional printing technologies have the genuine potential to improve medical treatments for conditions ranging from bone cancer and arthritis to glaucoma and hearing loss.

Already 3D bioprinting allows orthopaedic surgeons to print artificial bone from a scan of the patient, printing existing surgical materials to precisely the right shape to replace missing or damaged bone. For example, the technique has been recently used to create skull implants for people with head trauma and a titanium heel (pictured right) to replace heel bone that had been eaten away by cancer.

In the future, 3D printing technologies may be used together with advances in stem cell research to print living bone cells from patients’ own cells or functioning organs for transplant (such as kidneys or hearts).

3D bioprinting is one of the latest developments in ‘personalised medicine’.

The technology could enable doctors to tailor treatments to individual patients, rather than developing a treatment that works well for most patients with that condition.

But 3D bioprinting also raises a number of ethical questions that will need to be considered as these technologies develop.

Three ethical issues that are raised are: justice in access to health care, testing for safety and efficacy, and whether these technologies should be used to enhance the capacity of individuals beyond what is ‘normal’ for humans.

Justice and access

One major concern about the development of personalised medicine is the cost of treatments. Until recently it has been thought that advances in personalised medicine go hand-in-hand with increasing disparities in health between rich and poor. Should these treatments only be available to those who can pay the additional cost? If so, then those patients who lack financial resources may not receive effective treatments that others can access for a range of serious conditions.

Personalised medicine is most closely associated with research in genomics and stem cell therapies.

Advantages of personalising medicine are most obvious in cases where the condition affects patients in very different ways and standardised treatments offer imperfect benefits. For example, conditions affecting the growing bones of children are among those where personalising treatments, if these can be adapted to the rapidly changing bodies of children, can make a very big difference in the child’s comfort and capacity to participate in ordinary childhood activities and play.

Until recently, the cost and time required to provide a series of customised prostheses of different sizes for a child who has lost a leg to cancer, for example, has been prohibitive for many patients. 3D printing will bring down the time and cost of customising and producing prosthetic legs. In cases like that of Ben Chandler, printers can also be used for implants, which might avoid the need to amputate the original limb, even where significant bone loss has occurred.

The capacity to use 3D printing technology to substantially reduce the cost of prosthetics, or orthopaedic surgery to restore lost bone structures, means that this area of personalised medicine can avoid the criticism that personalised medicine inevitably increases the cost of health care and puts effective personalised treatments out of the reach of many patients.

Will 3D printing treatments be safe?

A second ethical concern about any new treatment, including the use of 3D printing, is how we can test that the treatment is safe and effective before it is offered as a clinical treatment.

In the case of 3D printing to replace bone, the materials used — for example titanium — are those already used for orthopaedic surgery, and have been tested for safety over a long period and with many patients, so it is unlikely that there are new risks from the materials.

In the future, 3D printing may be used in combination with stem cell derived cell lines.

This could lead to the development of printed functioning organs that can replace a patient’s damaged organ, but without the risk or rejection associated with donor organs, because it uses that patient’s own cells.

How can we know in advance that these treatments are safe? Unlike the case of developing a new drug, a stem cell therapy can’t be tested on a sizable number of healthy people prior to being tested on patients and then, finally, being made available as a standard treatment. The point of using a patient’s own stem cells is to tailor the treatment quite specifically to that patient, and not to develop a treatment that can be tested on anybody else.

Researchers combining 3D printing with personalised stem cell therapies beyond the experimental stage will need to develop new models for testing their treatments for safety and effectiveness.

Regulatory bodies that give approval for new treatments, such as Australia’s Therapeutic Goods Administration (TGA), will also need to establish new standards of testing for regulatory approval before these treatments can become readily available.

This means that even if researchers were ready to print a functioning prosthetic organ, it will be quite some time before patients with kidney disease should expect to be offered a 3D printed prosthetic kidney that uses their stem cells as a routine treatment.

Human enhancement

The third issue is whether or not we should use 3D printing for human enhancement.

If the technology can be used to develop replacement organs and bones, couldn’t it also be used to develop human capacities beyond what is normal for human beings?

For example, should we consider replacing our existing bones with artificial ones that are stronger and more flexible, less likely to break; or improving muscle tissue so that it is more resilient and less likely to become fatigued, or implanting new lungs that oxygenate blood more efficiently, even in a more polluted environment?

The debate about human enhancement is familiar to the context of elite sport where athletes have sought to use medical technology to extend their speed, strength or endurance beyond what is ‘natural’, or what they are able to achieve without drugs or supplements. In that context use of performance enhancing drugs is considered to cheat other athletes, unbalancing the level playing field.

In the case of 3D bioprinting enhancement of human capacities could be associated with the military use of the technology and the idea that it would be an advantage if our soldiers were less susceptible to being wounded, fatigued or harmed in battle.

While it is clear that it would be preferable for military personnel to be less vulnerable to physical harm, the history of military technology suggests that 3D printing could lead to a new kind of arms race. Increasing the defences that soldiers have in the face of battle would lead to increasing the destructive power of weapons to overcome those defences. And in so doing, increasing the harm to which civilians are exposed.

In this way 3D printing may open up a new gap in the vulnerabilities of “enhanced” combatants and civilians, at a time when the traditional moral rules concerning warfare and legitimate targets is muddied by terrorism and insurgency.

These three points might just be scratching the surface of new, deeper ethical and social issues that will emerge as the technology progresses.

The future of 3D bioprinting applications holds the promise of better treatment while challenging communities to address emerging ethical questions.

ABC.NET.AU
by Professor Susan Dodds | 11 February 2015