Simpleware Case Study: Oncological Pre-Surgical Planning, Virtual Simulation, and Surgical Guides with 3D LifePrints

PI/II Hemipelvectomy

In this case, 3D LifePrints were requested to create sterilizable surgical guides to assist in the partial removal of a patient's left hemipelvis because it was compromised by a tumorous mass. An expedited service was required due to the urgent surgery date for resecting the tumor. Simpleware ScanIP Medical was used to segment the patient’s most recent MRI and CT scans to create a virtual model of the left hemipelvis with the sarcoma. This sarcoma was then digitally grown by a safe surgical margin, and highlighted for better differentiation, to help the surgeon review and determine optimum surgical cutting planes.

Three different surgical guides were produced by 3D LifePrints, including one to enable a biplanar cut through the ilium for the lateral aspect, another allowing a single cut through the pubis, and a third directing a single cut through the ischium. All three guides were printed using the sterilizable and USP Class VI biocompatible cleared material "Biomed Clear" on a Formlabs 3B 3D Printer at 3D Life Prints' controlled environment facility which is located within the hospital itself.

3D LifePrints were able to satisfy the urgency of the surgical request by creating the anatomical model and designing and manufacturing the guides within 5 days. The surgical team used the anatomical model and guides as a pre-operative tool to engage the patient in a detailed discussion of the tumor re-recurrence and metastasis. Intra-operatively, the guides fitted optimally, and allowed for a single posterior extensile approach to be used, resulting in a significant reduction in operating time.

Targeted Resection of Ilium

In this second example, the case involved a patient who presented with a non-symptomatic Grade 1 chondrosarcoma that had been identified in a routine scan for a separate investigation. The tumor was small and localized in the patient’s left ilium, and so the surgeon wanted to carry out a targeted, bone-conserving resection to preserve the integrity of the ilium whilst ensuring that adequate margins were used.

3D LifePrints therefore designed and delivered a patient-specific sterilizable surgical drill guide for this operation. Simpleware ScanIP Medical was used to segment both bony and tumorous structures from the patient’s CT and MRI scans. These anatomical structures were then combined to create a virtual model in which the tumor was grown digitally to create a safe surgical margin. This margin was highlighted for better visualization so the surgeon could determine an optimal path for resection.

A patient-specific, circular drilling channel guide was produced by 3D LifePrints using Biomed Clear and delivered to the surgical team with a 3D printed anatomical model for intra-operative reference.

With the guide, which fitted well, the surgeon was able to make the necessary drill holes to guide the subsequent osteotomy, making the operation extremely straightforward and complete within an hour. Overall, the surgical team appreciated the level of precision the guide enabled. This precision meant that the tumor could be resected with safe margins whilst preserving the sacroiliac joint and avoiding neurovascular structures. Post-operatively, the patient experienced a quick rehabilitation period.

Conclusions

The range of applications and surgical specialties now being developed by 3D LifePrints, and their close involvement with clinical sites through embedded hubs, shows the great ongoing potential for bringing patient-specific digital and devices products and services closer to the point of care. We’re proud that Simpleware software can support 3D LifePrints to achieve fast and efficient workflows to go through medical imaging to 3D prints and other virtual methods designed to help improve patient care.