Dec 2, 2015 | By Alec

Over the last few years, the use of 3D printing in (academic) hospitals has been skyrocketing. While a few biomedical successes have already been realized with the help of 3D printing, most cases involve detailed surgical models based on a patient’s CT scans. These are used to prepare surgeries for particularly complex cases, and this method has already been applied to much success to limbs, rib cages, even organs and skulls. But as far as we are aware, specialists from the Texas Children's Hospital in Houston have reached a new milestone: they have used 3D printing to successfully separate conjoined twins.

All photos: RADIOLOGICAL SOCIETY OF NORTH AMERICA/TEXAS CHILDREN'S HOSPITAL

This groundbreaking approach has just been reported on in a study presented to the annual meeting of the Radiological Society of North America (RSNA). This is particularly impressive, because conjoined twins are notoriously difficult to separate because they often share organs and blood vessels. Since separation procedures have been implemented in 1950, about one of the twins survives in 75% percent of cases. The condition itself is very rare – about one in every 200,000 live births results in a conjoined twin (also called Siamese twins after an infamous circus side show act).

The twins in question were Knatalye Hope and Adeline Faith Mata, from Lubbock, Texas, who were born on April 11, 2014. They were conjoined from the chest to the pelvis. As the study’s lead author Rajesh Krishnamurthy, chief of radiology research and cardiac imaging at Texas Children's Hospital, said, it was an example of a particularly complex conjoined twin. ‘This case was unique in the extent of fusion’ he said. ‘It was one of the most complex separations ever for conjoined twins.’

But fortunately, the twins did not rely on the same vital organs. ‘The CT scans showed that the babies' hearts were in the same cavity but were not fused,’ Dr. Krishnamurthy said. ‘Also, we detected a plane of separation of the liver that the surgeons would be able to use.’ This appeared out of scans typically made for a surgery like this, involving a 320-detector scanner and intravenous fluids that provide contrasts in vital structures. They also relied on target mode prospective EKG gating techniques, which freeze the motion of the hearts on the image to get a more detailed view of the cardiovascular anatomy.

But this is where things changed. The Texas team used these CT scans to build a 3D printed color-coded model, complete with skeletal structures and supports 3D printed in plastic resin, with the organs being done in a rubber-like material. To make the complicated liver structures easier to study, these were 3D printed in transparent resin with major blood vessels done in white material. All in all, this life-sized model was extensively studied as part of the surgical preparation process, enabling the team to understand the ins and outs of the complex operation that followed.

They found it to be very helpful and the models proved to be exact replicas of the actual situation. ‘The surgeons found the landmarks for the liver, hearts and pelvic organs just as we had described,’ Dr. Krishnamurthy said. ‘The concordance was almost perfect.’ The models were also used to help parents Elysse and John Eric Mata understand exactly what was coming. ‘When I showed the mother the model and explained the procedure, she held my hand and thanked me. They said, 'For the first time, we understand what is going to happen with our babies’,’ the surgeon recalled.

The surgery itself took place on 17 February, when the twins were about 10 months old. The surgery involved 12 surgeons, six anesthesiologists and eight surgical nurses, and lasted 26 hours. It was, fortunately, a complete success. The babies went home about a month later, and are still doing well.

And while we’ve already been advocating its advantages for quite some time, Dr. Krishnamurthy is now also completely convinced about what it can do. He told the audience that he expects that 3D printing will become a standard tool for surgeons in the near future, especially for these kinds of complex cases. ‘The 3-D printing technology has advanced quite a bit, and the costs are declining. What's limiting it is a lack of reimbursement for these services,’ he said. ‘The procedure is not currently recognized by insurance companies, so right now hospitals are supporting the costs.’

 

 

Posted in 3D Printing Application

 

 

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