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3D printing is changing surgery

Steve Fletcher, from Freelance Surgical Ltd, tells us how 3D printing is currently used and what the technology might bring to the profession in the future

13 April 2018, at 2:15pm

Three-dimensional printing, also known as additive printing, is a computer-controlled process by which a 3D shape is built by adding layer upon layer of material. The technology has been developing over the last 25 years and is now starting to appear in veterinary surgery; it is likely that some of the products you’re already ordering and using are 3D-printed.

What are the key uses of 3D printing in the veterinary profession? 

In the veterinary market, this technology is used to produce several key products. CT scans can be utilised to make accurate, 3D-printed plastic models of deformed or complex anatomy. These scans are accurate to the submillimetric degree; they facilitate operational planning and enable implants to be precisely sized and contoured in advance of a procedure, effectively enabling a surgeon to practice a procedure before entering the operating suite. Another popular use of this technology is in the production of bespoke, sterile surgical guides for use in highly-complex surgical interventions. These guides may include deformity corrections, vertebral stabilisations and complex fracture alignments. Each guide is manufactured specifically for an individual case to improve the surgical outcome.

Model of a complex pelvic fracture in a feline patient, with actual multiplanar reconstruction of the CT in the background (images supplied by VetCT: www.vet3d.co.uk)
Model of a complex pelvic fracture in a feline patient, with actual multiplanar reconstruction of the CT in the background (images supplied by VetCT: www.vet3d.co.uk)

A new use of 3D printing is the printing of bespoke surgical implants directly, using titanium powder. This process enables unique implants to be manufactured for specific challenging cases. Implants are designed directly from the CT scan and can be manufactured to any style, shape or dimension.

The final key use is to manufacture unique internal structures within surgical implants. As the implants are built up in layers, the internal structure can be controlled at the microscopic level. This level of control was not possible before 3D printing. Fusion TTA implants offer an example of this technology, where the internal structure of their titanium implants has been designed akin to trabecular bone to optimise osseointegration and bone in-growth.

Bespoke pancarpal arthrodesis plate – distal radial tumour (images supplied by CBM wales: www.cbmwales.co.uk)
Bespoke pancarpal arthrodesis plate – distal radial tumour (images supplied by CBM wales: www.cbmwales.co.uk)

What makes 3D printing so valuable? 

3D printing enables tailored, one-off products to be manufactured with internal structures that have never been available before. They can be manufactured from a wide range of different materials, are infinitely flexible and produce minimal waste when compared to standard manufacturing processes. 

Fusion TTA implant
Fusion TTA implant

What is the future of 3D printing? 

Will vets soon be printing their own patient-specific implants in clinics? Currently, the titanium printing machine costs more than £500,000, so this seems unlikely. But 3D printing will become the standard manufacturing technique, rather than being considered a cutting-edge technology. Current research into 3D printing is focusing on printing using biological materials, so in future, perhaps there is potential for printing a tissue or organ on demand. 

Tissues are already being printed for use in drug development, and many billions of pounds are being invested to make this a reality.

Fusion TTA post-op radiograph (images supplied by Fusion Implants: www.fusionimplants.com)
Fusion TTA post-op radiograph (images supplied by Fusion Implants: www.fusionimplants.com)

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