In recent years, the field of healthcare has witnessed a growth in application of 3D planning and printing technology. This innovative approach has revolutionized surgical planning and patient care. Surgeons and healthcare providers are increasingly harnessing the power of 3D planning and printing to personalize treatment plans, improve surgical precision, and enhance patient outcomes.
This interview delves into the experiences and insights of a leading practitioner Dr Rahul Jain at Medanta Hospital, Gurugram, Haryana, who has been an experienced user of 3D planning and printing technology into surgical practice. Through their expertise and firsthand accounts, we explore the impact of 3D planning and printing on surgical innovation, patient care, and the future of healthcare.
Dr Rahul Jain is a fully qualified oral and maxillofacial surgeon who underwent training in maxillofacial surgery from KLE Belgaum, Karnataka. After joining the department of Plastic, Aesthetic and Reconstructive Surgery, he completed his fellowship in craniofacial surgery. He also underwent certified training in microvascular surgery from Ganga Hospital, Coimbatore.He has devoted himself exclusively to the refinements in Cranio-maxillofacial reconstruction by introducing and promoting the use of computer assisted planning and 3d printing.
Could you share your initial experience with 3D planning and printing technology? How did you get started with using 3D planning and printing technology in your practice? and what were the motivating factors that led you to adopt this technology?
Since 2015, I’ve been dedicatedly working at Medanta, a renowned hospital in Gurugram, Haryana. In 2016, while attending an advanced AOCMF course on orbital floor reconstruction, I encountered Dr. Lee, who introduced me to the innovative use of 3D planning and printing technology in this field. His method involved mirroring the intact side of the orbit onto the affected side virtually using 3D planning software, creating a precise 3D model for shaping titanium mesh, thus replicating the original orbital anatomy accurately.
This encounter sparked my interest in 3D planning and printing technology, prompting me to delve into it further. However, back then, obtaining such technology in India was challenging. Outsourcing the work to companies abroad was costly and time-consuming. To overcome this hurdle, I, along with my colleagues, decided to invest in Materialise 3D Planning software but handle the modeling and printing in-house, making it more economically feasible.
The encouragement and support from my seniors at Medanta, particularly Dr. Khajanchi, our esteemed chairman, played a pivotal role in my pursuit. Dr. Khajanchi’s forward-thinking approach and eagerness to embrace new technologies inspired me to explore 3D planning and printing further. He provided the necessary resources, including funding for the software and a compatible laptop, enabling me to embark on this journey of innovation and advancement in surgical techniques.
How has 3D planning and printing (Surgical guide, personalized implants) transformed the way you provide personalized care to your patients?
Before the advent of 3D planning and printing technology, our approach to surgeries like cranio-maxillofacial (CMF) procedures was primarily two-dimensional, relying on CT scans, X-rays, or intraoperative estimations. Despite years of experience, achieving precise results remained challenging. However, with the integration of 3D planning and printing technology, our ability to deliver precise outcomes underwent a transformative change.
Virtual surgical planning has been a game-changer in CMF surgery. Preoperative planning now occurs in a virtual space, allowing for meticulous preparation. , For example, a mandibular resection followed by reconstruction using a free fibular flap. Previously, surgeons would manually reset the mandible and rely on approximations intraoperatively, leading to potential errors. Now, every aspect, from resection to reconstruction and even the design of surgical guides, is meticulously planned beforehand.
This shift has eliminated intraoperative uncertainties and streamlined procedures. With surgical guides translating preoperative plans into precise actions, the surgical process has become smoother and more predictable. Consequently, surgical time has significantly reduced, which is a significant relief considering the previous apprehensions surrounding complex procedures like free fibular flap reconstructions.
Moreover, the increased precision has allowed us to push the boundaries of what was once considered feasible. Previously, there was a reluctance to pursue certain procedures due to their complexity and associated risks. Now, with reduced surgical times and enhanced precision, we can confidently offer patients improved quality of life outcomes, even in challenging cases like free fibular flap reconstructions.
Can you share a specific case where pre-surgical 3D planning and printing was used to create a personalized treatment plan or surgical device for your patient? How has 3D planning and printing technology impacted the outcomes of your surgeries?
I wish to discuss about Craniosynostosis. Craniosynostosis stands out among various conditions due to its complex nature. It involves the premature fusion of skull sutures, hindering proper brain growth and leading to skull deformities or increased intracranial pressure. The implications can range from constant headaches to severe deformities or even mental retardation in extreme cases.
Addressing craniosynostosis necessitates meticulous planning and precision. Traditional methods, reliant on eyeballing or lacking preoperative plans, fall short in achieving optimal outcomes. Instead, comprehensive preoperative planning, often facilitated by 3D planning and printing technology, becomes imperative.
The process involves creating a detailed preoperative plan, replicated during surgery with the aid of surgical guides. These guides assist in accurately cutting and rearranging the cranial segments, akin to solving a jigsaw puzzle. The inclusion of fixation guides ensures proper alignment and stabilization during reconstruction.
The integration of virtual surgical planning and surgical guides has revolutionized craniosynostosis treatment. It has not only streamlined surgical procedures but also significantly improved precision and reduced operative time. The remarkable outcomes speak for themselves, with patients experiencing enhanced postoperative results that closely match the preoperative plans.
In short, the adoption of 3D planning and printing technology and meticulous preoperative planning has paved the way for achieving exceptional precision and outcomes in craniosynostosis surgeries, marking a significant advancement in surgical practice.
What are the challenges of using 3D technologies for cranial-maxillofacial surgery?
One of the initial hurdles in adopting 3D planning and printing technology for cranio-maxillofacial (CMF) or plastic surgeons is the steep learning curve. For those venturing into in-house planning, acquiring the necessary skills poses a significant challenge, requiring dedicated training and practice. Additionally, securing funding is essential to invest in the required software and equipment.
However, the challenges extend beyond just mastering the technology. A major concern arises when there’s a need to deviate from the preoperative plan during surgery. Despite meticulous planning and the creation of surgical guides and custom plates, unforeseen circumstances, such as an oncologic surgeon needing to extend resection margins due to unexpected findings, can disrupt the planned procedure. In such instances, reverting to conventional methods becomes necessary, highlighting the importance of being proficient in both traditional and advanced techniques.
Moreover, turnaround times for 3D planning and printing services, whether outsourced or managed locally, present logistical challenges. Waiting periods of a week or more may be manageable for routine cases but prove impractical for urgent scenarios, such as aggressive cancers or international patients requiring immediate treatment. While efficient planning and printing can mitigate some delays, the reliance on external services still imposes limitations.
Another significant consideration is the increased cost associated with 3D planning and printing technology. Additional charges for software, equipment, and outsourcing services add to the financial burden on patients. However, these costs are often justified by the time saved during surgery and the enhanced precision offered by the technology.
Overall, the adoption of 3D planning and printing technology in CMF surgery brings several benefits but also presents challenges that must be addressed. These include the steep learning curve, the need to navigate changes in intraoperative plans, logistical constraints regarding turnaround times, and the financial implications. Overcoming these challenges requires a comprehensive understanding of both traditional and advanced techniques, as well as careful planning and resource management.
Can you share with us your thoughts on implementing an in-house 3D POC (Point of Care) facility which serves the multidisciplinary teams? Will a 3D POC facility be able to accelerate the planning process by having a shorter turnaround for the printing of surgical models or splints (in house)?
Before delving into the challenges of incorporating patient-specific planning (PSP), it’s essential to understand the three primary models for its implementation. The first model involves outsourcing the entire process to specialized companies. These companies handle everything from planning to printing, based on provided DICOM images. While this approach offers convenience, it may lack the intimate involvement of the surgeon and can lead to potential discrepancies in the final outcome.
The second model entails in-house virtual surgical planning and 3D printing. Here, the surgical team takes charge of the entire process, utilizing dedicated software and equipment to plan and print surgical guides or implants. This hands-on approach allows for greater surgeon involvement, resulting in fewer intraoperative complications and a deeper understanding of the surgical plan.
The third model, a hybrid approach, combines in-house planning with outsourced printing. This model offers the best of both worlds, leveraging the expertise of local printing services while maintaining control over the planning process. At Medanta, we opt for this hybrid model, benefiting from quick turnaround times while ensuring surgeon involvement in the planning phase.
The decision to adopt in-house planning and printing comes with its own set of challenges. One major concern is ensuring accuracy and precision in the planning process. While outsourcing may seem efficient, it often lacks the nuanced understanding of surgical intricacies that comes with direct surgeon involvement. By taking control of the planning process, surgeons can mitigate potential errors and ensure the best possible outcome for their patients.
Furthermore, in-house planning can lead to cost savings and reduced turnaround times. With advancements in 3D printing technology, desktop printers are becoming increasingly affordable and precise, making in-house printing a viable option for many institutions. This shift towards in-house patient-specific planning reflects a growing trend in surgical practice, driven by a desire for greater control, efficiency, and cost-effectiveness.
Overall, while the adoption of in-house patient-specific planning presents its own challenges, it offers significant advantages in terms of surgeon involvement, accuracy, and cost-effectiveness. As technology continues to evolve and become more accessible, we can expect to see further advancements in this field, empowering surgeons to deliver better outcomes for their patients.
As a closing thought, where do you see the future of 3D planning and printing going? How do you think the technology will change the landscape of cranial-maxillofacial surgery in the next 5-10 years?
In our ongoing project still in the research and development (R&D) phase, we’re exploring the integration of augmented reality (AR) or virtual reality (VR) technology into surgical planning. Our approach involves utilizing AR to project virtual surgical guides directly onto the patient’s leg, eliminating the need for physical guides. While this method streamlines the process, we’re currently addressing the challenge of providing haptic feedback to guide the surgeon’s actions, ensuring precision during the procedure.
One of our key objectives is to expand beyond bone planning to include soft tissue planning. Unlike bone, soft tissue presents unique challenges due to limitations in imaging. While current imaging techniques may not provide sufficient detail to accurately separate fat, skin, and muscle, advancements in imaging technology hold promise for overcoming these limitations in the future. We’re already experimenting with 3D cameras to facilitate soft tissue planning, although this aspect is still in the refinement and R&D phase.
Looking further ahead, the concept of bioprinting holds immense potential for revolutionizing healthcare. The ability to print tissues, organs, and even entire organs could transform the treatment landscape. While this technology may still be several decades away from realization, it represents a significant milestone in medical innovation.
In the next 5-10 years, we anticipate that 3D printing and planning will transition from being an optional accessory to becoming a standard of care in surgical practice. As more hospitals adopt these technologies, ensuring optimal outcomes will become a key differentiator among healthcare providers. This shift towards widespread adoption poses both opportunities and challenges, as institutions vie to establish themselves as leaders in the field.
How do you think personalized care empowered by 3D planning and printing technology can be more accessible and affordable for patients?
Absolutely, making these technologies more accessible and affordable is key to widespread adoption and improved patient care. Several strategies can contribute to lowering costs and increasing accessibility, such as , , improvements in desktop 3d printers, education and training, and in-house point of care model
Constant advancements in desktop 3D printing technology have made these printers increasingly affordable and accessible. By leveraging these cost-effective alternatives to industrial 3D printers, healthcare facilities can reduce expenses associated with in-house printing.
Integrating 3D planning and printing technology training into academic curricula for surgeons and biomedical engineers ensures that future professionals are proficient in utilizing these tools. By providing education and training opportunities, institutions can empower individuals to adopt these technologies effectively.
Establishing in-house point-of-care models allows healthcare facilities, regardless of location, to take advantage of 3D planning and printing technology. By reducing the need for outsourcing and associated costs, this model makes these technologies accessible to a broader range of healthcare providers and patients.
By implementing these strategies and promoting education and training initiatives, we can democratize access to 3D planning and printing technology, making it more affordable and accessible to healthcare providers worldwide. This, in turn, will lead to improved patient outcomes and a more equitable healthcare system.
You have special interest in Plastic, Aesthetic and Reconstructive Surgery, how can 3D planning and printing technology help for the patients in your specialty. How do you think, 3D planning and printing technology should progress to help doctors treating Plastic, Aesthetic and Reconstructive Surgery cases.
Over the past 7-8 years, the utilization of 3D planning and printing technology has become increasingly prominent for plastic, aesthetic and reconstructive Surgery cases, particularly in oncological cases, where mandibular reconstruction using free fibula bone grafts is prevalent.
Another common application is in orthognathic surgeries, addressing facial bone abnormalities such as overgrown mandibles or receded maxillas. 3D planning and printing technology facilitates virtual surgical planning and soft tissue simulation, offering patients a preview of their post-surgery appearance. This not only enhances patient acceptance but also boosts conversion rates, as patients gain confidence in the anticipated outcomes.
Furthermore, 3D planning and printing technology is instrumental in addressing congenital deformities like cleft lip and craniosynostosis, where abnormal fusion of cranial sutures leads to skull deformities. It is also invaluable in cases of trauma or post-ablative reconstruction, where patients seek restoration following mandibular or maxillary resections.
Patient-specific implants, which can be titanium, PEEK, or 3D-printed, are utilized to achieve optimal outcomes. Additionally, in acute trauma scenarios, such as orbital fractures, 3D printing orbital models aid in surgical planning and serves as a template for titanium mesh bending.
While these represent primary applications, often cases present with a combination of challenges, requiring a comprehensive and personalized treatment approach. In such instances, a blend of 3D planning and printing techniques is employed to develop tailored surgical plans that address the unique needs of each patient.
Materialise Mimics Medical has been helping many doctors like Dr Rahul Jain in improving patient outcomes and advancing patient-centric care with 3D technologies
Materialise Medical has pioneered many of the leading medical applications of 3D printing, enables researchers, engineers and clinicians to revolutionise innovative patient-specific treatment that helps improve and save lives. Materialise Medical’s open and flexible platform of software and services, Materialise Mimics Medical, forms the foundation of certified Medical 3D printing, in clinical as well as research environments, offering virtual planning software tools, 3D-printed anatomical models, and patient-specific surgical guides and implants. For additional information, please visit: https://www.materialise.com/en/healthcare/hcps/point-of-care-3d-printing
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