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How 3D printing could revolutionise surgery

Someone should reach out to the thoracic surgeon, Mr Ehab Bishay, to find an alternative manufacturing location. CISIRO is great but something in the UK would make the next implant (and the ones after that) less of a "multi-national collaboration".

From bbc.co.uk - How 3D printing could revolutionise surgery - Feb 1, 2017

Surgeon Gabriel Weston witnessed a remarkable UK first – an operation to implant a custom built 3D printed titanium sternum.

Several years ago Edward Evans fell seriously ill when an infection began eating away at his sternum – the bone at the centre of the ribcage that protects the vital organs in the chest. Medication failed to eradicate the problem, so Edward had to undergo surgery to have the infected sternum and parts of his adjacent ribs removed.

At the time, it was impossible for the surgeons to do anything more than cover the resulting defect with Edward’s own muscle, because putting any foreign object into his chest when infection was rampant would almost certainly have resulted in that foreign material also becoming infected.
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Normally in situations like this the implant would be made from a hand moulded cement block wedged in a synthetic mesh. This is a tried and tested method, but surgeons have always been searching for a better, more modern alternative.

In Edward’s case thoracic surgeon Mr Ehab Bishay was able to offer such an alternative – a bespoke sternum made from titanium and 3D printed on the other side of the world.

Titanium is a strong, lightweight, biologically compatible metal that becomes integrated, not rejected in human bodies. And this, coupled with advances in 3D printing technology, allowed the creation of an implant that would precisely fill the defect in Edward’s chest.

Mr Bishay sent CT scans of Edward’s chest to Anatomics Pty Ltd in Melbourne, Australia, who are world leaders in the design and manufacture of bespoke surgical implants.

Their designs were then sent to CSIRO where they were fed into a 3D printer. This printer has a chamber filled with powdered titanium, and the particles are fused together layer by layer by an electron beam.
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Before the procedure, these tests showed that when Edward was inhaling parts of his chest were moving inwards instead of outwards. But after the operation this had been corrected and his breathing and movement were in synchrony again.

3D printing offers great potential for the future of surgery – not only can parts be created that precisely fit a particular patient, but the materials used can minimise the risk of infection. For thoracic surgeons like Mr Bishay, this technology is exciting because it could allow them to commission bigger and more complex implants to help patients like Edward, and to help patients who have lost bones due to chest wall tumours.

This procedure was only the first of its kind in the UK and the second in the world – so it’s going to be fascinating to see how this technology develops.




The same story told somewhat differently at 3dprintingindustry.com - Further advances in healthcare with implant of 3D printed titanium sternum

More images were shown here with photographic credit given to the BBC.


Cardiothoracic surgeon, Ehab Bishay and the patient Edward Evans. Photo via Stratford-Upon-Avon Herald.



It seems from the programme that the sternum was printed using an Arcam machine. Image via BBC.



The 3D model of the sternum implant using AnatomicsC3D software. Image via BBC.




Studley man receives 3D titanium sternum and ribs in Heartlands op - 2nd Feb, 2017

Cardiothoracic surgeon, Mr Ehab Bishay, from Heart of England NHS Foundation Trust, had read of the world’s first 3D implant by a team of surgeons in University Hospital Salamanca, Spain. They had collaborated with Australia-based medical device company, Anatomics, creating a custom built titanium implant that precisely replicated the structure of a sternum and rib cage in a cancer patient which was then implanted.

Mr Bishay said: “We approached Anatomics initially, who put us into touch with the team from Salamanca. It was a real multi-national collaboration.”

The team in Australia used high-resolution CT scans of Edward’s chest to recreate the defect so the implant would precisely fit. This data was then fed into a 3D printer that uses a powerful electron beam, to melt and fuse metal powder into a 3D object, layer by fine layer.

“Although cement is tried and tested we believe that custom built 3D printed titanium implants may have certain advantages which we are looking to show,” said Mr Bishay.

“Titanium is more resistant to infection, lightweight, tough, and since it exactly replicates the defect, it means the operative time is reduced as it slots in. It should also offer a better cosmetic result.”

Edward spent five days in hospital and now nearly five months after his surgery, has made a full recovery.

He said: “I feel more confident now. My chest now feels like it did before. Whatever I do now — simple or difficult — I feel better doing it. I can even fall over, knowing my heart and lungs are protected, and that’s something I couldn’t do before.

“I am very grateful to Mr Bishay and thank him and the rest of the medical team involved for the excellent treatment I received at Heartlands Hospital before, during and after surgery.”