3D printing is certainly one of the innovations that will technologically define an era, and perhaps in a few decades we will remember these years as the pioneering era of this production technique. It is one of the most promising and revolutionary technologies, with applications in various fields, not least that of health. So it is good to ask yourself some questions: what help can 3D printers give to medicine, our health and the improvement of health treatments?

A valid example of excellence and innovation comes from the General Surgery Department of the Sacra Famiglia Fatebenefratelli Hospital in Erba (LC), where thanks to the use of a Sharebot 3D printer it was possible to reproduce real anatomical organs and structures to perform simulations of surgical interventions or some fundamental surgical steps, such as that of videolaparoscopic cholecystectomy.

The experimentation phase in collaboration with Sharebot led to the creation of a model that represented a section of the liver and its gallbladder using a particular printing material (LAY-FOMM) available in spools of filament. The latter, after having spent a period in water, thanks to its bi-material porous composition (a rubbery part and a soluble PVA-based part), proved to be particularly similar to organic tissues, also allowing the sealing of the surgical stitches comparable to that of live tissues. The consistency and tension capacity combined with the residual moisture maintained after immersion in water were found to be comparable to their organic counterparts.

3D printed liver and gallbladder
Operation carried out inside Pelvic Trainer (laparoscopic simulator)

Surgical training for high fidelity simulations

These achievements allowed the hospital surgical team to simulate a videolaparoscopic cholecystectomy directly on the printed models. In practice, it involves removing the gallbladder without causing damage to the underlying liver tissue. This operation, carried out inside a Pelvic Trainer (laparoscopic simulator) allows surgeons to learn the correct technique and experiment with new non-invasive removal techniques. Thanks to the ability to simulate essential surgical interventions or steps on 3D printed anatomical models with high fidelity, a great step of technological and medical innovation is taken, essential to increase the chances of patients who will have to undergo a similar operation in real life.

Some considerations and images from the hospital surgical team

The peculiarity of the model developed by us is that it to also provides two different infills between the liver and the gallbladder with the possibility of making the gallbladder empty (infill 0%) to fill it with colored liquid to also simulate the bile (gall) content. The liver, thanks to its elastic capacity, is also used as a support to optimize the technical capabilities of laparoscopic stitches and traditional sutures.

The liver and gallbladder in a single model are joined directly by support structures. Using the Raft and the Supports we then developed a model of only the gallbladder in which raft and support, mimicking the hepatic bed, allow to simulate the section plane with the liver. This model is composed only of the gallbladder and allows an important saving of filament resulting also faster to print.

3D printed gallbladder

In the latter we have developed a reduction of the space between the support and the gallbladder in order to make the section between them more complex and realistic. As an improvement in the positioning inside the pelvic trainer (laparoscopic simulator) we have created an anatomical base with a liver made with PLA material on which we have applied a soft sponge (which mimics the delicacy of a real liver) on which a component has been inserted in cork which is used to make the 3D gallbladder models made with LAY-FOMM easily insertable and interchangeable. This rigid model allows the replacement of gallbladder models in LAY-FOMM more simply and quickly.

Anatomical base with a liver made with PLA

Finally we have created an ellipsoidal cylindrical model with a vertical opening that allows to simulate intestinal sutures and intestinal anastomoses. This model is cheap and quick to print.

Models for intestinal sutures

The future possibilities are certainly manifold and remarkably vast. We’d like to increase the number of models on different organs in order to promote a high-fidelity simulation of several essential surgical procedures or steps. To this end we would like to learn how to set up a 3D printing from DICOM files to be able to print, in addition to standard cases, also particularly complex or particular clinical cases that are sometimes encountered in clinical practice. In general, 3D printing with LAY-FOMM interests us to promote innovative, technological and above all practical training of new surgical generations through increasingly advanced and high-fidelity simulations.

The printer used by the Fatebenefratelli Hospital Team is the Sharebot 43 (now replaced by Sharebot Creator 3 Pro), a professional 3D printer equipped with an independent dual extruder that allows you to print soluble supports for the most complex geometries and, above all, to print with the Mirror and Duplicate system. The flexible printing bed reaches 120°C, while the 43 extruders reach a maximum temperature of 300°C, which also allows you to print technical and professional materials that meet the most varied physical, chemical and mechanical conditions such as high or minimum temperatures, oils and petrol, shocks and rubbing.

The collaboration of Sharebot and the Department of General Surgery of the Fatebenefratelli Hospital in Erba has made it possible to highlight the importance of the adoption of 3D printing in the innovation field, opening the doors to new types of simulations and high-fidelity surgical training. This application is just one of the possible scenarios that this technology allows to explore. Whether it is reproductions of organs for experimental phases or implantable prostheses in patients, 3D printing is already becoming a key tool in the branch of medicine innovation.

Sharebot is a young and innovative company, with 4 different 3D printing technologies, the last of which is the metal 3d printing, with an R&D that is always updated and operational on the innovations that these modern technologies can offer. It boasts over 3,500 printers around the world including 160 in universities. It ranks among the first places in Europe and the only one on the continent with 4 3D printing technologies: filament, resin, thermoplastic and metal powders.