Content Credits : Ashish Aryan, Advika Rajagopal
Design Credits : Ashish Aryan
Webpost Credits : Saachi Girish Kurudi
Imagine a world where surgeons can hold a patient’s tumor in their hands before making the first incision, where prosthetics are crafted with such precision that they feel like a natural extension of the body, and where human tissues are printed layer by layer like an artist sculpting a masterpiece. This isn’t science fiction—it’s the reality 3D printing is bringing to modern medicine, particularly in surgical oncology.
Three-dimensional printing (3D printing, 3DP), also known as rapid prototyping or additive manufacturing, has existed since the 1970s, but only recently has it made its way into the operating room. The advent of affordable, high-resolution desktop 3D printers after 2010 has enabled researchers and surgeons to develop personalized models, implants, and even bioengineered tissues, ushering in a new era of patient-specific medicine.
How 3D Printing Works
At its core, 3D printing builds physical structures layer by layer from digital 3D models. This process allows for customization at an unprecedented scale, revolutionizing surgical planning, training, and patient care. Various techniques are employed in surgical oncology, each suited to specific applications:
Fused Deposition Modeling (FDM): This technique melts thermoplastic filaments and extrudes them layer by layer to create anatomical models, allowing surgeons to visualize tumors in three dimensions before operating.
Stereolithography (SLA): SLA printers use ultraviolet lasers to cure liquid photopolymer resins, producing high-resolution structures that replicate the intricate details of human tissues.
Selective Laser Sintering (SLS): A laser selectively fuses powdered materials, generating complex 3D models with remarkable durability and precision, making it ideal for printing surgical guides and implants.
Electron Beam Melting (EBM): This method employs electron beams to fuse metal powders, creating strong, biocompatible implants used in orthopedic and reconstructive oncology surgeries.
Applications of 3D Printing in Surgical Oncology
1. Personalized Precision: Custom Tumor Models for Surgical Planning
Traditional imaging methods such as CT scans and MRIs provide crucial insights into tumor characteristics. However, these two-dimensional images often make it challenging for surgeons to fully comprehend a tumor’s relationships with surrounding structures. 3D printing fills this gap by generating patient-specific models, enabling surgeons to:
- Enhance Preoperative Planning: Surgeons can physically examine and manipulate printed tumor models, leading to better surgical strategies and fewer surprises in the operating room.
- Improve Patient Communication: Patients and their families can see and touch 3D-printed models, helping them better understand their condition and the surgical approach.
- Train Medical Professionals: 3D-printed models allow trainees to practice complex procedures before performing them on real patients.
For example the printed brain can be combined with the tumor print (red) in order to establish the relationships of the adjacent anatomic structures. The tumor can be painted to determine the separation from the brain parenchyma. This is a cost-effective procedure that can help improve the three-dimensional visualization and management of brain tumors.
1.1 Custom Implants and Prosthetics
For cancer patients undergoing major resections, 3D-printed implants offer a great level of personalization. This is particularly beneficial in cases requiring craniofacial or orthopedic reconstruction, where traditional implants may not provide an ideal fit.
The above image shows,
a) a 12 year old patient with osteosarcoma of the distal femur,
b) the planning of the custom made 3D printed, removable plate, and
c) shows the same on the patient after surgery.
1.2 Customized Surgical Tools and Guides
Traditional surgical instruments are mass-produced and standardized, often limiting their suitability for intricate surgeries such as in oncosurgery. 3D printing allows for the development of:
- Patient-Specific Guides: These guides ensure precise tumor excision while preserving as much healthy tissue as possible.
- Surgical Jigs: These guides integrate imaging data with real-time navigation, enhancing surgical accuracy.
In the above image,
A) In generating the implant model, 3D data are transferred to a 3D implant image of the skull bone and tumor using computer-aided design.
B) Digital assembly of the defective skull model and modeled implant.
C) surgical jig was made to be used to guide the excision of the same.
2. Intraoperative Assistance:
By combining 3D-printed models with advanced imaging technologies, surgeons can have real-time guidance during surgeries. These printed models can be equipped with markers that help align the surgeon’s movements with imaging data, enabling more precise tumor removal.
- Integration with Augmented Reality (AR): These allow printed models to be superimposed onto real-time imaging, enhancing spatial awareness during surgery.The image shows the formation of a 3d model using data from 2d scans, followed by making the 3d model after refining and then using the data to enable a virtual reality surgical planning.
- Fluorescent Markers in Printed Models: These embedded markers help align surgical instruments with imaging data, improving navigation in minimally invasive procedures.
3. Post-Operative Care and Monitoring
3D printing is increasingly being used to track the recovery process, particularly when it comes to the reconstruction of body parts and the assessment of surgical outcomes.
Personalized follow-up models can help in assessing the potential for recurrence of tumors, giving healthcare providers the ability to track progress in a more individualized way.
Challenges and Ethical Dilemmas
Despite its transformative potential, 3D printing in oncology faces several hurdles:
- Regulatory Barriers: Strict approval processes slow down the integration of 3D-printed implants into mainstream medicine.
- Material Limitations: Further research is needed to develop biocompatible and long-lasting printing materials.
- High Costs: Advanced 3D printing technologies remain expensive, limiting accessibility in lower-resource settings.
Conclusion
3D printing is not just reshaping surgical oncology—it is redefining what is possible in medicine. As technology continues to advance, its integration into cancer treatment will only deepen, offering surgeons, researchers, and patients new hope in the fight against cancer. In the near future, what was once thought impossible may simply be a matter of printing it into reality.
References
- Beltrami G, Ristori G, Nucci AM, Galeotti A, Tamburini A, Scoccianti G, Campanacci D, Innocenti M, Capanna R. Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients. J Clin Med. 2021 Mar 4;10(5):1056. doi: 10.3390/jcm10051056. PMID: 33806387; PMCID: PMC7961419.
- https://www.sciencedirect.com/science/article/pii/S1878875020326395
- https://www.sciencedirect.com/science/article/pii/S2949916X2400118X#:~:text=Benefits%20of%203D%20printing%20in,of%20clinical%20outcomes%20%5B21%5D
- Cornejo J, Cornejo-Aguilar JA, Vargas M, Helguero CG, Milanezi de Andrade R, Torres-Montoya S, Asensio-Salazar J, Rivero Calle A, Martínez Santos J, Damon A, Quiñones-Hinojosa A, Quintero-Consuegra MD, Umaña JP, Gallo-Bernal S, Briceño M, Tripodi P, Sebastian R, Perales-Villarroel P, De la Cruz-Ku G, Mckenzie T, Arruarana VS, Ji J, Zuluaga L, Haehn DA, Paoli A, Villa JC, Martinez R, Gonzalez C, Grossmann RJ, Escalona G, Cinelli I, Russomano T. Anatomical Engineering and 3D Printing for Surgery and Medical Devices: International Review and Future Exponential Innovations. Biomed Res Int. 2022 Mar 24;2022:6797745. doi: 10.1155/2022/6797745. PMID: 35372574; PMCID: PMC8970887.