3D PRINTING: A BREATH OF FRESH AIR IN MEDICAL SCIENCE
Additive manufacturing procedures are increasingly used in today’s business, and 3D printing is one such method. It’s the procedure of making a three-dimensional object from a computer model. Not very long ago, 3D printing in medicine was only a far-fetched fantasy that is now made tangible and accessible by putting in a lot of time and effort. 3D printing has come a long way in recent years, allowing for the quick creation of medical implants and altering how doctors and surgeons organize treatments to serve patients better. Although 3D printing is just one of many potential uses for this technology, it has quickly become the most significant development in the medical industry in recent years1.
To print the model of an implant or graft, technically, five steps2 are involved. The first step is to select the anatomical target area carefully and then develop the 3D geometry by processing medical images obtained from a CT or MRI scan. The third step is to optimize the file for the physical printing process and pick the right 3D printer and materials. To prepare for eventual printing, the fourth step involves using this file for “slicing” the digital design model into portions. Finally, a 3D printer will receive this “sliced” design and construct the thing layer by layer, beginning with the base layer and continuing until all the necessary raw materials have been used. A patient-specific, anatomically accurate model is developed using imaging data.
Introducing 3D models in surgery has led to an immense advantage for developing nations. To support the current global industrial and supply chain systems, a substantial amount of infrastructure is required, which can only be created and maintained by economies with sufficient purchasing power, such as those in North America and Europe3. Many people in low-resource nations lack the financial wherewithal to afford the things designed for the industrialized world. 3D printing (3DP) technology can “democratize manufacturing,” making it possible for people from all walks of life to create new and valuable goods4. Compared to traditional manufacturing businesses, the initial investment and infrastructure needed to launch a 3DP plant are far lower.
Further, 3D printing eliminates the requirement for pre-production and warehousing by allowing manufacturing to be ramped up quickly to an infinite amount. Another perk is the rapid reduction or elimination of tooling expenses across several manufacturing lines—something incredibly helpful for people who require immediate medical attention. The World Health Organization (WHO) reports that fifty and eighty percent of medical devices donated to low-resource hospitals are non-functional, meaning that healthcare personnel often lack the necessary equipment to provide crucial care. Using 3D printing technology to create customized healthcare supplies might be one answer to this issue. The creation of medical equipment was an early use case for 3D printing. The medical device industry greatly values the many advantages of 3D printing, including its low-cost relative to design complexity, adaptability, and rapid turnaround times.
All surgeons need implants that are faster, cheaper and have better outcomes than the previously available models and the implications of 3DP have been far-fetched in these regards. In an analysis carried out in 2006, Computer-Aided Surgical Simulation in Complex Cranio-Maxillofacial surgery has been shown to offer cost-effectiveness compared to standard operating procedures. Similarly, the implications of 3DP in thoracic surgery leading to reconstructed models of pulmonary arteries using 3D rapid prototyping, allowing replication of sophisticated anatomical structures like pulmonary arteries, have been described and are used to facilitate anatomic study, surgical planning, and device development. 3D physical models have been reported helpful in the surgical treatment of complex acetabular and clavicle fractures. The models aid in a better understanding of acetabular fractures and significantly reduce interobserver variation in the classification of these fractures. The metal plates could also be placed on the fracture bone model and bent to match the reduced bone fracture surface before surgery. The immense advantages of 3DP in surgery do not just stop here. Endovascular aortic procedures are also being carried out using this technology. An article suggests that a unit that performs 200 EVARs a year might see an economic return on material costs, including an in-house printer of 50 000 USD.
There has been no shortage of praise heaped upon the application of 3-D printing in surgery. Studies have shown it reduces operation theater costs, saving time for the surgeons and near-perfect implants and devices, aiding surgeons to breeze past the difficulty of tailoring the graft or an implant to individual patient needs5. This begets a question as to how accurate these claims are. Is a new age finally here? Yes, it is. But the problems mentioned above are not solved one hundred percent. A systematic review shows that the time spent preparing the model is commonly cited as a drawback, offsetting any potential benefits from the reduced work required to perform the procedure.
Consequently, it appeared that imaging and data processing took far longer than the printing process itself. Creating a basic drill guide using 3D modeling might take many hours. Therefore, the value of time saved might be evaluated differently depending upon the stage at which we start to keep time6.
One study found that 403 euros per operation may be saved by employing 3D printing technology; in this instance, the amount of time saved would likely outweigh the price of the 3D model. Another factor is the projected reduction in analgesic and antibiotic use resulting from a shorter anesthetic duration and a shorter total operating time. However, making broad assumptions about such computations across hospitals is challenging because of the variety of contextual elements that must be considered7.
Several surgical teams raised concerns about the technique’s organizational impact, noting that the necessity of close collaboration across a wide range of parties was a significant challenge. Most surgeons lack the specialized knowledge necessary to work with 3D software. This leads to some surgeons being skeptical about losing control over the choices that will have an impact on their patients given the enormous responsibility they bear during the crucial preoperative planning stage.
Finally, post-printing processes like cleaning, finishing, and sterilization are crucial for supplying acceptable and faultless 3D-printed physical products to surgical teams. Few materials which are pivotal to making these products are unstable when they are autoclaved.
Numerous eminent research institutions have embraced 3DP because they understand how it could be used to print the medical future. However, like with all previous technological revolutions, there are understandably some worries. To transform healthcare, 3D printing in the medical industry and design needs to look beyond the box. The three key foundations of this innovative technology are the capacity to treat more individuals where it was previously impractical, achieving patient results, and requiring less time in the direct care of medical specialists. In a few words, 3D printing can be best described as “enabling doctors to treat more patients, without sacrificing results” 8
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References
1. Martelli, Nicolas, et al. “Advantages and disadvantages of 3-dimensional printing in surgery: a systematic review.” Surgery 159.6 (2016): 1485-1500.
2. Aimar, Anna, Augusto Palermo, and Bernardo Innocenti. “The role of 3D printing in medical applications: a state of the art.” Journal of healthcare engineering 2019 (2019).
3. Rismani, Shalaleh, Van der Loos, and H. F. Machiel. “The competitive advantage of using 3D-printing in Low-resource healthcare settings.” (2015): 495-504.
4. Huang, Yong, et al. “Additive manufacturing: current state, future potential, gaps and needs, and recommendations.” Journal of Manufacturing Science and Engineering 137.1 (2015).
5. Ballard, David H., et al. “Medical 3D printing cost-savings in orthopedic and maxillofacial surgery: cost analysis of operating room time saved with 3D printed anatomic models and surgical guides.” Academic radiology 27.8 (2020): 1103-1113.
6. Macario A. What does one minute of operating room time cost? J Clin Anesth 2010;22:233-6.
7. . Lethaus B, Poort L, Bockmann R, Smeets R, Tolba R, € Kessler P. Additive manufacturing for microvascular reconstruction of the mandible in 20 patients. J Craniomaxillofac Surg 2012;40:43-6.8. Liaw, Chya-Yan, and Murat Guvendiren. “Current and emerging applications of 3D printing in medicine.” Biofabrication 9.2 (2017): 024102.
