We can receive data securely over the internet directly from your PACS system, or on physical media. Please contact us for further details.
PATIENT-SPECIFIC DIGITAL 3D SURGICAL PLANNING SUPPORT
We can help you rehearse, test, and optimise your surgical approach through careful 3D planning in a computer environment; long before the patient arrives in the operating theatre.
Common benefits of 3D pre-planned surgery include:
· reduced risk, especially in complex procedures 1, 2;
· reduced dependence on multiple, expensive physical models which are destroyed after one practice 1, 3;
· creating 3D-printed polymer anatomical models of the outcomes (either by PDR or by your hospital) 3;
· enabling PDR’s experienced design engineers to realise your designs for custom surgical guides;
· using those guides to accurately translate digital plans, and reduce operation durations 1-5; even when compared to expensive robotic 6, and navigation-based approaches 7.
Usually, we will establish your particular requirements during a web-meeting, and enact your plans on virtual models of the anatomy as you watch and direct. This might mean defining the precise margins for disease excision, or verifying the availability and shape of a proposed reconstructive bone graft.
We will translate your prescription into 3D files of verified designs for patient-specific implants and guides; which are suitable for 3D printing in titanium. By meticulously defining your design requirements, we can model your designs to be effective and safe. Devices must always be made by appropriately qualified manufacturers. We can arrange for verified designs to be manufactured by leading 3D printing experts, Renishaw PLC who are certified to rigorous international medical device quality standards, and who comply fully with medical device regulations.
Our design expertise and our robust procedures are supported by our own peer-reviewed academic investigations, and by regular review of the current state-of-the-art.
Patient-specific surgical guides can be used to control:
· drilling locations 8;
· drilling angles 9, 10;
· saw cutting vectors 11-13;
· the repositioning of bones 1, 3, 14;
· the stability of residual bones following resection but prior to grafting 15;
· and the shape of auto-grafts themselves 3, 16.
Compared to adaptable mass-produced stock implants, 3D printed implants have:
· achieved a more accurate fit with better stability 17;
· resulted in better functional outcomes 18;
· resulted in better aesthetic outcomes despite extra surgical constraints 2, 19;
· reduced theatre time 2, 3, 20;
· reduced the likelihood of needing surgical revisions 21;
· decreased stress shielding 22;
· avoided limb amputations 23;
· increased the safety of procedures for theatre staff 24;
· incorporated tailored mechanical properties 25;
· resolved the most complex and non-standard defects 1, 26;
· and improved osseointegration, where desired 27.
Additionally, positive secondary effects have been reasonably inferred; such as reduced infection risks and blood loss 28, and accelerated recovery periods 29. See our portfolio for representative examples of previous maxillofacial device designs.
SURGICAL TRAINING AND SIMULATION MODELS
We can develop surgical training and simulation models that allow you to practice procedures. Our product and industrial design expertise; particularly in mould tool design, 3D printing processes, casting processes, and in working with silicone materials; mean that we can cater to specific pathologies or traumatic scenarios.
Benefits of this service:
· Models can tailored to meet your needs in terms of area of anatomy, tissue representation, fidelity of anatomical structures, etc.
· Use of cadaveric materials could be reduced.
· Models offer repeatability and consistency, and could therefore be used as part of research studies.
See examples of our previous work below.
Please contact us directly using the details below, to discuss your particular needs.
1. Peel S, Eggbeer D, Sugar A and Evans PL. Post-traumatic zygomatic osteotomy and orbital floor reconstruction. Rapid Prototyping Journal. 2016; 22: 878-86.
2. Peel S, Bhatia S, Eggbeer D, Morris DS and Hayhurst C. Evolution of design considerations in complex craniofacial reconstruction using patient-specific implants. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 2017; 231: 509-24.
3. Bibb R, Eggbeer D and Paterson A. Medical Modelling: The Application of Advanced Design and Rapid Prototyping Techniques in Medicine. 2nd ed. Cambridge, UK: Woodhead Publishing, 2015, p.182.
4. Tarsitano A, Battaglia S, Ciocca L, Scotti R, Cipriani R and Marchetti C. Surgical reconstruction of maxillary defects using a computer-assisted design/computer-assisted manufacturing-produced titanium mesh supporting a free flap. Journal of Cranio-Maxillofacial Surgery. 2016; 44: 1320-6.
5. Honigmann P, Thieringer F, Steiger R, Haefeli M, Schumacher R and Henning J. A Simple 3-Dimensional Printed Aid for a Corrective Palmar Opening Wedge Osteotomy of the Distal Radius. J Hand Surg Am. 2016; 41: 464-9.
6. Jaffry Z, Masjedi M, Clarke S, et al. Unicompartmental knee arthroplasties: robot vs. patient specific instrumentation. Knee. 2014; 21: 428-34.
7. Kaneyama S, Sugawara T and Sumi M. Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system. Spine (Phila Pa 1976). 2015; 40: e341-8.
8. Bibb R, Eggbeer D, Bocca A, Evans P and Sugar A. A Custom-fitting Surgical Guide. In: Kau CH and Richmond S, (eds.). Three-Dimensional Imaging for Orthodontics and Maxillofacial Surgery. Wiley-Blackwell, 2010, p. 243-52.
9. Vrielinck L, Politis C, Schepers S, Pauwels M and Naert I. Image-based planning and clinical validation of zygoma and pterygoid implant placement in patients with severe bone atrophy using customized drill guides. Preliminary results from a prospective clinical follow-up study. International Journal of Oral and Maxillofacial Surgery. 2003; 32: 7-14.
10. O’Malley FL. The development of innovative patient-specific surgical guides. Cardiff Metropolitan University, 2016.
11. Bibb R, Eggbeer D, Evans P, Bocca A and Sugar A. Rapid manufacture of custom-fitting surgical guides. Rapid Prototyping Journal. 2009; 15: 346-54.
12. Foley BD, Thayer WP, Honeybrook A, McKenna S and Press S. Mandibular Reconstruction Using Computer-Aided Design and Computer-Aided Manufacturing: An Analysis of Surgical Results. Journal of Oral and Maxillofacial Surgery. 2013; 71: 111-9.
13. Eggbeer D and Peel S. The Role of Computer Aided Design & 3d Printing in Post-Traumatic Deformity Correction. In: Perry M and Holmes S, (eds.). Atlas of Operative Maxillofacial Trauma Surgery, Post-Traumatic Deformity. 1st ed. London: Springer-Verlag London, 2018.
14. Herlin C, Koppe M, Béziat JL and Gleizal A. Rapid prototyping in craniofacial surgery: Using a positioning guide after zygomatic osteotomy – A case report. Journal of Cranio-Maxillofacial Surgery. 2011; 39: 376-9.
15. Reiser V, Alterman M, Shuster A, et al. V-stand--a versatile surgical platform for oromandibular reconstruction using a 3-dimensional virtual modeling system. J Oral Maxillofac Surg. 2015; 73: 1211-26.
16. Soleman J, Thieringer F, Beinemann J, Kunz C and Guzman R. Computer-assisted virtual planning and surgical template fabrication for frontoorbital advancement. Neurosurg Focus. 2015; 38: e5.
17. Kim D, Lim J-Y, Shim K-W, et al. Sacral Reconstruction with a 3D-Printed Implant after Hemisacrectomy in a Patient with Sacral Osteosarcoma: 1-Year Follow-Up Result. Yonsei Medical Journal. 2017; 58: 453-7.
18. Sanna S, Brandolini J, Pardolesi A, et al. Materials and techniques in chest wall reconstruction: a review. The Journal of Visualized Surgery. 2017; 3.
19. Goodson AMC, Evans PL, Goodrum H, Sugar AW and Kittur MA. Custom-made fibular “cradle” plate to optimise bony height, contour of the lower border, and length of the pedicle in reconstruction of the mandible. British Journal of Oral and Maxillofacial Surgery. 2017; 55: 423-4.
20. Shuang F, Hu W, Shao Y, Li H and Zou H. Treatment of Intercondylar Humeral Fractures With 3D-Printed Osteosynthesis Plates. Medicine. 2016; 95: e2461.
21. Singare S, Lian Q, Wang WP, et al. Rapid prototyping assisted surgery planning and custom implant design. Rapid Prototyping Journal. 2009; 15: 19-23.
22. Harrysson O, Cansizoglu O, Marcellin-Little DJ, Cormier DR and West Ii HA. Direct metal fabrication of titanium implants with tailored materials and mechanical properties using electron beam melting technology. Advanced Processing of Biomaterials Symposium, Materials Science and Technology Conference and Exhibition. Cincinnati, Ohio, USA2008, p. 366-73.
23. Hsu AR and Ellington JK. Patient-Specific 3-Dimensional Printed Titanium Truss Cage With Tibiotalocalcaneal Arthrodesis for Salvage of Persistent Distal Tibia Nonunion. Foot Ankle Spec. 2015; 8: 483-9.
24. Rana M, Chui CHK, Wagner M, Zimmerer R, Rana M and Gellrich N-C. Increasing the Accuracy of Orbital Reconstruction with Selective Laser Melted Patient-Specific Implants Combined with Intraoperative Navigation. Journal of Oral and Maxillofacial Surgery. 2015; 73: 1113-8.
25. Parthasarathy J, Starly B and Raman S. A design for the additive manufacture of functionally graded porous structures with tailored mechanical properties for biomedical applications. Journal of Manufacturing Processes. 2011; 13: 160-70.
26. Wyatt MC. Custom 3D-printed acetabular implants in hip surgery--innovative breakthrough or expensive bespoke upgrade? Hip Int. 2015; 25: 375-9.
27. Palmquist A, Snis A, Emanuelsson L, Browne M and Thomsen P. Long-term biocompatibility and osseointegration of electron beam melted, free-form–fabricated solid and porous titanium alloy: Experimental studies in sheep. Journal of Biomaterials Applications. 2011; 27: 1003-16.
28. Lethaus B, Poort L, Böckmann R, Smeets R, Tolba R and Kessler P. Additive manufacturing for microvascular reconstruction of the mandible in 20 patients. Journal of Cranio-Maxillofacial Surgery. 2012; 40: 43-6.
29. Levine JP, Bae JS, Soares M, et al. Jaw in a day: total maxillofacial reconstruction using digital technology. Plastic and Reconstructive Surgery. 2013; 131: 1386-91.