MedicalExpo e-Magazine - #15 – 3D Printing in SurgeryMedicalExpo e-Magazine

The Smart Magazine About Medical Technology Innovations

3D Printing in Surgery




The future is definitely now. Beyond the ability to produce any kind of prosthetic or implant, the promising 3D printing technology—also called additive manufacturing—represents a huge advance in surgical planning by improving our understanding of anatomy. In this issue you will also read about cartilage regeneration and how 3D printed living tissues can survive outside the laboratory. Already tested in mice, it will not be long before bioprinted muscle, cartilage and bone will be implanted in human patients.

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Having a 3D model to examine before the operation has the potential to save time and money
Courtesy of James Duncan

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The rise of 3D printing represents a huge advance in surgical planning by improving our understanding of anatomy. One London hospital to recognize the potential of this promising technology is Charing Cross, which has an active surgical research laboratory.    James Duncan, clinical research fellow and the rest of the...


Hot Topics
The versatile bioprinting method can produce patient-specific cartilage grafts with good mechanical and biological properties
Courtesy of ETH Zurich

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Never a dull moment in the 3D printing and bioprinting field, scientists are moving forward on cell-friendly bioinks. On board for discussion during the 3D Medical Expo at MECC in Maastricht, The Netherlands in late January: cartilage regeneration and biomimetic scaffolds.

 

“It’s still in its early stages,” Dr. Marcy Zenobi-Wong said in an interview with MedicalExpo during the event. She leads the Cartilage Engineering + Regeneration research team at ETH Zurich, one of the leading technical universities in the world.

During her presentation, “BioPrinting Cartilage,” she spoke of “bioinks based on regulatory-compliant polysaccharides being developed which undergo cell-friendly gelation and yield a strong, ductile material.” They’re now making bioinks more tissue-specific and bioactive by adding micronized extracellular matrix particles to the mix.

The bioink supports proliferation and deposition of matrix proteins. This versatile bioprinting method can produce patient-specific cartilage grafts with good mechanical and biological properties.

Mixing Cells with Bioink

“We’re working on facial reconstruction,” Zenobi-Wong explained her team’s current research on bioprint solutions for those missing a part of their ear or nose from trauma or cancer. The steps begin with a biopsy of the patient’s tissue.

You need to start with cells from the patient. Isolate the cells from the biopsy, put them in culture in order to have a large number and then mix them with, what we call, bioink. The shape would be based on the CT.

Her team is moving forward on a bioprint solution for microtia which would “replace surgical procedures.” They also founded the company CellSpring which develops 3D printed microtissues for drug screening.

 

Courtesy of ETH Zurich

Courtesy of ETH Zurich

Cartilage Implants, Thinking End-use

While cartilage has already been bioprinted, the creation of “end-use” cartilage implants may require accurately and efficiently 3D printed biomimetic scaffolds.

Dr. Lorenzo Moroni and the team from MERLN Institute for Technology-Inspired Regenerative Medicine at Maastricht University began a study entitled “Multiscale fabrication of biomimetic scaffolds for tympanic membrane tissue engineering.”

Lorenzo and his team focused on 3D printing scaffolds without the use of cellular materials in the bioprinting process. They printed the scaffolds with EnvisionTEC’s 3D bioplotter, considered a bioprinter for cellular materials. However, they did not use cellular materials, but polymer based mixtures that are biodegradable and biocompatible.

 

 

80 People Walking, Literally, with 3D Printed Knee Constructs

“There have been more and more clinical translations for smart implants with additive manufacturing technologies,” Moroni told MedicalExpo in an interview at MERLN Institute. “Enough knowledge has been created over the last ten years or more in terms of how to optimize the implant structural and surface properties to have a proper interface with cells.

For bioprinting and the different applications, we will have to wait at least another five to ten years before we see the first number of clinical cases being tested.

Courtesy of 3D Printer

Courtesy of 3D Printer

Thirteen years ago, Moroni and his collaborators began working on an implant project to 3D-print scaffolds for knee cartilage. After 3D printing the scaffold, he and his team at CellCoTec strategically plant a patient’s cells and watch the cartilage grow.

The first four years, they gathered research and focused on creation; this was then taken up by the CellCoTec team. This step was followed by four years of developing the application to make sure it was up to industrial standards.

The project has been in clinical trial since 2010 and is on the market; clinical data is still collected to support reimbursement for this novel treatment. “There are about 80 people that are walking with those implants.”

 


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We implanted them in mice and rats; months later, blood vessels had formed
Courtesy of WFIRM

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The Wake Forest Institute for Regenerative Medicine reported in mid-February in Nature Biology successfully printing tissue with a custom-designed 3D printer, called ITOP (Integrated Tissue and Organ Printing System). The structures proved to be functional when implanted in animals. MedicalExpo talked to Dr. Anthony...


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  • Thermometer FDM Prototype (Courtesy of Stratasys)

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    A combination of radiology, computer-aided design (CAD), and additive manufacturing technologies have made it possible to create patient-specific models, implants, or tools to aid in surgeries worldwide. Spinal implants, cutting guides, and replicas of patients’ hearts are just a few of the ways in which digital manufacturing processes have improved the medical industry.

    As the techniques for implementing additive manufacturing technology for medicine are refined, there looms a crucial problem, which is a problem of access. While the FDA is slowly approving some uses of additive manufacturing, most of them are still in a holding pattern, and as such are not eligible for insurance reimbursement.

    If we can demonstrate that this process is intrinsically sterile, we would hypothetically be able to create patient-specific parts at an incredibly low cost.

    This problem is compounded by the tremendous cost of industrial additive manufacturing technologies so far the only kind of technologies that can print in autoclavable materials. These machines generally have tremendous footprints, and expensive proprietary material. The significantly more affordable hobbyist machines, while alleviating the issues of cost and size, are not able to print in autoclavable materials.


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    Courtesy of Movement Control Laboratory/University of Washington

    Two researchers from the University of Washington in Seattle have built what the specialized press considers to be the most amazing biomimetic, anthropomorphic robotic hand.

    The scientists started from scratch by laser-scanning a skeletal hand and then 3D-printing artificial bones to match. Those complex pieces were held together by a series of artificial ligaments made of high-strength Spectra strings. Laser-cut latex sheets replicated the soft tissue.

    Tendons also were replicated using Spectra springs, while muscles were replaced by 10 Dynamixel servo motors.

    The new robotic hand is able to very closely mimic a wide variety of grasps when controlled by a remote manipulator. The user can grab coins, CDs, bills, keys, coffee mugs, dental floss, cell phones, credit cards, and more.

    According to the researchers, their hand could also be used as 3D scaffolding for limb regeneration research.

     


    CONTRIBUTORS



    Erin Tallman

    Erin Tallman, writer for MedicalExpo e-magazine and Editor-in-Chief of ArchiExpo e-magazine.


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    Dima Elissa

    Dima is CEO and founder of VisMed-3D, a biomedical design and consulting firm.


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    Celia Sampol

    Celia Sampol has been a journalist for 15 years. She worked in Brussels and Washington for national medias (Agence France Presse, Liberation). She’s now the editor-in-chief of MedicalExpo e-magazine.


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    Anne Gulland

    Anne Gulland is a UK-based freelance journalist who has been writing about health and medicine for 20 years.


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    Kristina Müller

    Kristina Müller is a freelance journalist writing mainly about nautical and medical issues.


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    Kerry Sheridan

    Kerry Sheridan is an authors and health journalist based in Miami, Florida.


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