Patients recovering from surgery to excise breast and lung tumors can hope they can breathe easier thanks to replacement ribs made by high-tech 3D printers.
The implants are given to people who have had part of their chest wall removed during treatment, and are made using scans of the ribcage that are molded layer by layer in the printer to perfectly match the bones to be formed. to replace.
Traditional techniques to close holes in the ribcage, which give the surgeon access to cancerous areas, don’t always fit the anatomy well and can make breathing more difficult.
According to studies, the same problem is not seen in patients who have undergone the new method.
“If the opening is small, we sometimes seal it with surgical gauze,” says Andrea Bille, consultant thoracic surgeon at Guy’s and St Thomas’ NHS Foundation Trust in London. ‘But for large spaces, surgeons usually make a concrete implant that fills up the entire empty space, with no space between the ribs.
Patients recovering from surgery to excise breast and lung tumors can hope to breathe easier thanks to replacement ribs made by high-tech 3D printers
The pioneering work is being carried out by Guy’s and St Thomas’ NHS Foundation Trust in London, pictured
“Often the way the cement sets can leave too little room for the chest to expand during breathing. It meant that patients suffered from a tight chest and were unable to exercise.
‘Thanks to the new technique, the implant is shaped perfectly to the individual.’
About 48,000 Britons are diagnosed with lung cancer each year. About half of lung cancer cases are diagnosed when the disease has already spread, usually to nearby breast tissue.
While some of these tumors can be destroyed with radiotherapy alone, many tumors require surgery to remove them. In up to one in 10 cases, surgeons must remove at least part of the ribcage to access cancerous tissue.
As of 2018, some NHS surgeons have been using 3D printing technology to create bespoke implants made from layers of powdered titanium to replace these parts of the ribs. But titanium is not an ideal material, explains Mr. Bille: ‘It doesn’t conform well to the shape of the body and the metal is attached with screws, which can be painful.’
Scientists at King’s College London have instead developed replacement ribs made with smaller, strategically placed pieces of concrete, which are being offered to a small number of patients with advanced lung cancer or rare soft tissue tumors – called sarcomas – in the chest.
While a titanium implant is printed off-site and can take several weeks to complete, the new replacement can be made in just 48 hours. Titanium implants also cost around £1,000 per patient, while the new ones cost just £40.
For the new technique, surgeons make detailed CT scans of the area. The images, along with vital patient data such as age, height and weight, are fed into a sophisticated computer program that designs an exact replica of the patient’s ribcage. This is sent to the 3D printer, which makes a mold of each individual rib. These are then filled with concrete to create the implant.
A day or so later, the patient comes for the operation. Surgeons remove the bone area needed to access the tumor, along with cancerous tissue. They then attach the implant to the remaining bone with strong sutures before sewing the incision closed.
“Patients generally recover much faster than with previous implants,” says Bille. “They can exercise again in a few weeks instead of a few months.”
One patient benefiting from the new technique is 75-year-old Colin Rose from Kent, who underwent the procedure as part of a trial in 2019 after doctors found sarcoma cancer in his chest wall.
Surgeons removed three ribs and part of his sternum to take out all of the cancer and make sure it hadn’t spread.
All three ribs have been replaced using the 3D printing technique.
Colin has remained cancer free ever since. “My replacement ribs don’t give me any problems,” he said. “I asked my surgeon how long the ribs would last — and he jokingly said about 200 years. But they do feel very solid.’
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