Each year, over 2.4 million patients in acute and specialist hospital and community services are treated through Guy's and St Thomas' NHS Foundation Trust, which is one of the largest NHS trusts in the UK. Often for surgical planning purposes, surgeons across the Trust rely on multi-material 3D printing with technology from Stratasys. Planning out surgeries ahead of time using 3D printed medical models can save on costs and time in the operating room, which is better for both the surgeon and the patient. These patient-specific models also give patients and their families an easier way to understand the surgery.
The Trust’s transplant department is a major 3D printing advocate, and was responsible for using the technology in a historic surgery two years ago to successfully transplant a grown man’s kidney into his young daughter’s body. It is the first Trust in the world to pre-plan, using 3D printed models, the transplantation of an adult kidney into a small child with complex anatomical issues.
Now, Pankaj Chandak, the Transplant Registrar at Guy's and St Thomas' NHS Foundation Trust, who worked on this first surgery, has made medical magic happen again after partnering with Stratasys for the case of two-year-old Dexter Clark, who received a kidney from his father, Brendan Clark.
Dexter’s parents knew even before he was born that he would need a kidney transplant, and that his father would most likely be the donor. But the operation would be difficult, first because the risk was increased due to Dexter weighing less than 10 kg. In addition, Clark’s kidney was larger than average, so the surgical team didn’t know if it would be feasible, or even safe, to implant into Dexter’s abdomen.
Most surgeries like this rely on medical imaging for pre-surgical planning, but this only offers limited results. Instead, the team used a precision, multi-material 3D printer from Stratasys, purchased from its UK partner Tri Tech 3D, to make two patient-specific models: one of Dexter’s abdomen and one of Clark’s kidney.
“Using our 3D printer, we worked in collaboration with Nick Byrne and his team '“ clinical scientists from our medical physics department who specialize in medical imaging,” said Chandak. “They converted patient CT scans into anatomically accurate, multi-material 3D models. These helped us appreciate aspects such as depth perception and space within the baby's abdomen, which can often be difficult to ascertain when looking at conventional imaging. The ability to print a 3D model of the patient's anatomy in varying textures, with the intricacies of the blood vessels clearly visible within it, enables us to differentiate critical anatomical relations between structures. The flexible materials also allowed us to better mimic the flexibility of organs within the abdomen for simulation of the surgical environment.”
Normally, patients like Dexter would have to undergo anesthesia and a surgical exploration to determine whether a complex transplant like this one was possible. But thanks to Stratasys, the surgical team could instead use the 3D printed patient-specific models to non-invasively determine the feasibility, and optimal surgical approach, of the transplant.
The 3D printed anatomical models were present in the operating room, so Nicos Kessaris, the Consultant Transplant Surgeon at Guy's and St Thomas' NHS Foundation Trust, could review them during the surgery to determine the best way to fit the donor kidney into Dexter’s abdomen.
Chandak said, “This technology has the potential to really enhance and aid our decision-making process both during pre-surgical planning and in the operating room, and therefore can help in the safety of what is a very complex operation and improve our patient care.”
The surgery was a success, and Dexter, now fully recovered, is able to eat regular food without the use of a feeding tube for the first time in his young life.
“Since the transplant, Dexter is a changed boy, eating solid food for the very first time,” his mother, Emily Clark, said. “We always knew the operation would be complicated but knowing that the surgeons had planned the surgery with 3D models that matched the exact anatomy of my husband's kidney and son's abdomen, was extremely reassuring. We hope that Dexter's case will offer other suffering families similar reassurance that cutting-edge technology, such as 3D printing, can help surgeons better treat their loved ones.”
Heartwarming cases like these are a perfect example of how 3D printing can improve the success rates of complex, life-saving organ transplant surgeries for children.
“Guy's and St Thomas' NHS Foundation Trust is pushing the boundaries of what can be achieved with multi-material 3D printing within healthcare,” said Michael Gaisford, Stratasys' Director of Marketing for Stratasys Healthcare Solutions. “It is a clear demonstration of the ability for 3D printing to enable physicians to better plan, practice and determine the optimal surgical approach. We are delighted to see Dexter has fully recovered and hope many other children can benefit from such forward-thinking applications of our technology.”
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