3D Technology and the changing approach to complex surgery

To kick off 2023, clinical engineer? Stuart Watson will reveal the impact the use of 3D techniques is having in healthcare on proficiency, efficiency, and cost.

‘Measure Twice Cut Once’ is a proverb that all DIYers and building professionals know the value of. Planning and preparing reduces expensive mistakes, and if this holds for DIY, then how much more so for surgery.

To effectively plan for surgical procedures, surgical teams need accurate information of the patient’s anatomy. Traditionally this was provided by 2-dimensional images displayed on a flat screen: X-rays and CT scan slices for instance.

Modern 3d techniques however are rapidly developing, providing surgical teams with new visualisation and simulation tools. Making 3d planning methods accessible across the Northern Care Alliance NHS Foundation Trust is the role of the new Centre for 3d Surgical Planning and Innovation (3dSPIN), a collaboration between the Salford Care Organisation departments of ENT, Orthopaedic surgery, Anaesthesia, and NCA Medical Devices Service.

3d planning can be employed across a range of surgical disciplines. In orthopaedic surgery for instance, the surgery can be planned in software which enables the surgeon to simulate cuts and realignment of bone, and placement of plates to hold the bones in place until they fully heal.

In figure 1 below (left), the radius bone in a patient’s wrist was fractured and healed in an abnormal position. The 3d software Sectra, used across the organisation, allows the surgeon to plan the cut and move the bone into the correct position. A model of the metal plate provided by manufacturers can then be placed in position and the drill holes to fix the plate located.

It is also possible to design a custom cutting/drilling guide for the procedure, called a Patient-Specific – Instrument (PSI). This fits closely onto the bone during the surgery, aiding the surgeon in obtaining accurate cut and drill positions and alignments. The PSI for this surgery, shown in the figure 1 (right), was 3d printed in titanium which is extremely strong and biocompatible.

The bones, plates and guides can all be 3d printed, and used by the surgeon to simulate and practice the procedure beforehand, ensuring the outcome is as intended – figure 2 shows the surgeon simulating the cut and plate screw-hole drilling using a 3d printed model of the bone and the guide.?Similar planning models and guides can be produced for a wide range of surgical procedures.

What are the advantages of using 3d planning methods?

Medical journal publications have stated that the techniques can reduce theatre times for longer, more complex procedures by 1–2 hours not only aiding theatre availability but reducing time the patients spend under anaesthesia and post-operative stay. Perhaps of even greater impact, the information and preparation provided by 3d planning helps to reduce adverse outcomes and complications: 3d simulations can, and have, resulted in surgeons changing and refining their procedure plan based on the new information and feedback provided.

The models and simulation devices produced are not only useful in surgical planning, but as training tools for professional and student education, for patient communication, and to support research and development. Recent projects in 3dSPIN include the use of 3d modelling for virtual reality simulations, and in computational fluid dynamic modelling of patient airways.?

What does the future hold?

Since opening in mid-2022, 3dSPIN has supported over 50 ENT, spinal and orthopaedic surgical procedures.

Through 2023/24 the centre will be working closely with Research and Innovation at Northern Care Alliance colleagues to develop the service, bringing in additional 3d printing resources, and working to extend the availability of 3d planning support to more surgical specialities. The objective is to make these modern, powerful and cost-effective 3d planning tools and custom instruments easily accessible to surgical teams for their patients benefit, across the NCA.

Stuart Watson, Head of Clinical Engineering, Northern Care Alliance NHS Foundation Trust.

Thanks for reading our first edition of In Scope. We will be sharing more developments from the world of 3d spin over the coming months.

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