71-year-old Peter Maggs of Wales had no idea he had cancer when he went to the doctor for what he thought was a cyst in his chest. There was no pain, he said, but the cyst turned out to be a sarcoma that had grown to the size of a tennis ball. He needed surgery to remove the tumor, which was in the cartilage of one of his ribs, but the surgery, which took a day to carry out, would result in the removal of not only the sarcoma but three of his ribs and half his breastbone.
“It was a very extensive growth that needed to be removed,” said cardiothoracic surgeon Ira Goldsmith of Morriston Hospital. “However, removing it also meant removing part of the breastbone and three ribs. That would leave a large defect that could have destabilised the entire chest wall and reconstructing it was going to be a very complex procedure. Traditionally the operation would have used a cement prosthesis, prepared at the time of surgery. Although it can be fairly substantial it is not a precise fit, and it can move, causing problems such as dislocation.”
So instead of a traditional cement prosthesis, Goldsmith and fellow consultant surgeon Thomas Bragg, with the support of the Morriston surgical team, implanted a custom 3D printed prosthesis that fit perfectly into the gap left by the removal of Maggs’ ribs and breastbone. It was made from titanium, which is stronger and more stable than cement. Using the 3D printed implant not only gave Maggs much less of a risk of complications, it reduced the surgery time by about two hours, which was important because Maggs has heart problems and other health issues, so the surgeons wanted the surgery to be as quick as possible.
The implant was designed by Morriston’s biomedical 3D technician Heather Goodrum and maxillofacial laboratory service manager Peter Llewellyn Evans, using Maggs’ CT scans to create a perfect fit. It was 3D printed by Renishaw, the first time such an implant has been 3D printed in the UK.
Originally, the implant was supposed to have been screwed in, but as the bone was soft and narrow there was a chance that it could break so it was sewed into place instead. It was then covered with a section of latissimus dorsi muscle which Bragg had harvested from Maggs’ upper back. The entire procedure took about eight hours.
“We are very pleased with the outcome. The implant is a perfect fit,” said Goldsmith. “Titanium is very strong and any problems like dislocation are reduced or even eliminated because the implant is anchored securely to the ribs and breastbone.”
Morriston Hospital leads the ADEPT Project, or Additive-manufacture for Design-led Efficient Patient Treatment, which involves the use of 3D printing to produce titanium implants. Renishaw is a partner in the project, which has been focused mainly on maxillofacial implants; Maggs is the first person in Wales to have his chest rebuilt with a 3D printed implant.
Goldsmith will give a presentation at the British Sarcoma Group meeting later this month, as well as the Society for Cardiothoracic Surgery in Great Britain and Ireland annual meeting in Glasgow next month.
“It was the first time for this procedure to be carried out in Wales and because of its success we plan to carry it out again in the future,” he said. “We have also liaised with Swansea University and together we are drawing up protocols enabling other surgeons around the world to learn from us so they can use this technique on their own patients.”
You can see a brief interview with Maggs and Goldsmith below:
Discuss this and other 3D printing topics at 3DPrintBoard.com or share your thoughts below.[Source/Images: Abertawe Bro Morgannwg University Health Board]