First ever pectus excavatum correction surgery with 3D printed titanium plate completed in China

Sep 14, 2015 | By Alec

As regular readers might have observed, Chinese surgeons and academic hospitals are very readily adopting 3D printed implants and surgical models in their procedures, which is leading to some very groundbreaking surgeries. And another has just been completed, as doctors in the TangDu Hospital of the fourth Military Medical University in Xi'an city, Shaanxi province, China, have recently and successfully completed a complex pectus excavatum procedure in which a 3D printed titanium alloy plate was implanted into a young girl’s chest all. It was the first time 3D printing technology was used in such a rare and complex surgery, that absolutely requires a customized approach. In short, it was nothing but a major breakthrough.

The patient in question was the 18 year old Xia Ling, from the Shanxi province, a student who had recently finished her entrance examination for the University of Medical Science (majoring in clinical medicine). Unfortunately, she had been suffering from chest wall deformities since she was a child, resulting in severe pectus excavatum, spine scoliosis, left thorax are concave, and right thorax convex. In her case, the Haller index for pectus excavatum is 6.76, with a funnel being about 15cmx15cmx6cm in size and 45 cm3 in volume. ‘The patient's chest wall deformity is very serious, with the chest 'hole' being as big as a bowl,’ explained Thoracic surgeon Huang Lijun, who is Deputy Director at the hospital. She had previously undergone two deformity correction surgeries, which both failed.

This condition occurs in about three in 10,000 people, and correction becomes increasingly difficult as patients become older. Little complications tend to occur when a patient is about four to six years old, as the rib cage recovers quickly. But as the age increases, the likelihood of surgical success decreases. Mistakenly, many parents believe that this condition is caused by calcium deficiency, Huang Lijun says. Adding more calcium to a diet doesn’t solve the problem. Pectus excavatum can further be divided into three categories: light, medium and heavy. When occurring at birth, sometimes it is not very serious as it can correct itself over time. However, when still occurring around the ages of four to six, surgery is advised if assessed as medium or heavy.

This time around Xia Ling and her father came to the TangDu hospital, hoping for an unconventional method to relieve pain and rebuild her rib cage, which would obviously also do wonders to restore her confidence. This did, however, required the abandoning of traditional methods and adopting 3D printing. Upon admission to the hospital, Director Li Xiaofei and Professor Huang Lijun, and their team, discussed the situation several times. As traditional surgical approaches had already failed twice (which involved lifting the sternum and implanting an orthopedic plate), they needed something else. Due to the tremendous advances made in medical 3D printing, they opted for a 3D printed and fully personalized orthopedic plate this time.

With the surgical plan decided upon, the TangDu medical 3D printing group – that includes professor Cao Tiesheng, surgeon Dr Huang Lijun, Dr. Wang Lei, ultrasound diagnostic Department’s Dr Wang Zhen, and technician Yang Guanying, spent two weeks designing and 3D printing a custom plate made from titanium alloy. It was designed to fit snugly within the chest, and is retractable to match the patient’s chest size. Not only would it be a perfect fit, it also overcomes the restrictions that conventional plates place upon the thorax. Being so happy with the concept, they have already applied for a national patent.

After rigorously planning the surgery, surgeons Huang Lijun, Wang Lei, Guo Haihua and Yang Feng jointly worked to implement the plate. This took about six hours, during which the misshapen sternum was raised by nearly 5 cm. The surgery was a success, and both the patient and her family were very happy with the orthopedic effect.

What’s more, this can go into the medical history books as being the first time 3D printing was used to implement a customized corrective plate during a pectus excavatum surgery, and it probably won’t be the last as 3D printing has brought a lot of advantages to the table. ‘The plate fits snugly within the chest, and we have also added a telescopic adjustable structure to the plate,’ Dr Wang Lei said. ‘The traditional method depends on clinical experience, meaning that it is difficult to do a good simulation before operation, and now with the development of science and 3D printing technology, we have achieved a completely personalized surgical procedure that greatly improves the safety of operation.’

Another problem with the traditional approach is that the plate needs to be taken out again within two years. But due to the patient’s young age and her own weak physical condition, her recovery period is even longer than that. Fortunately, 3D printing has also offered a solution here. ‘We added an adjustable structure on the plate, which can be automatically adjusted within her chest along with the development of her body. It can be made longer, so it can better serve its purpose of remodeling the Thoracic outlet,’ Huang Lijun said, adding that this is a breakthrough for the pectus excavatum patient.

Posted in 3D Printing Applications

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