Better surgery through 3D printing
Through nation's first 3D printing surgical fellowship, alumni and faculty use anatomy replicas to improve the surgery experience for physicians and patients
July 29, 2022
Imagine: a surgeon has a patient with a complex case. Maybe the patient has unusual anatomy. Maybe their tumor is in a difficult location.
The surgeon orders a scan, uploads it to her computer and hits print. At the end of the hall, the department's 3D printer creates what she needs – a replica of the patient’s unique anatomy, a model of the difficult tumor embedded within the organ.
That's the future that Michael Amendola, M'02, H'07, F'09, and Diana Otoya, M'19, know is coming. And through a new surgical fellowship at the Central Virginia VA Health Care System (CVHCS) in Richmond, they're preparing surgeons for that future. The fellowship is the only one of its kind in the nation – at the forefront of a 3D printing revolution in medicine.
Led by Amendola, chief of vascular surgery at CVHCS and professor in the VCU Department of Surgery, the 12-month fellowship trains surgeons in the art and science of 3D printing. Fellows learn how to consult with other surgeons about the case, scan the anatomy properly, work with engineers on the 3D model and engage with patients.
"We work in a three-dimensional world. We operate in it. We solve problems in it," Amendola says. "The anatomy should be presented, ideally, in 3D."
For surgeons, that means being better prepared to enter the operating room. A 3D-printed model of a tumor's precise location in the brain can show the surgeons how to remove the least amount of brain tissue in their approach. In another case, a 3D-printed kidney helped surgeons decide against an operation and pursue different treatment.
In one case, Otoya highlights a patient with rare anatomy, an aortic arch that's right-sided – rather than on the left – and as a result was compressing the esophagus, impeding swallowing.
"I've been working with the vascular surgeon to print that relational anatomy," she says. "Then we can take it to the cardiac surgeon. It will help ease the surgical planning and improve communication between the two teams, if they can visualize the ligaments and where the compression is happening."
For patients, 3D printing means a higher level of informed consent. The patient with the rare arch could hold the printed aorta in his hands and understand the surgical approach.
"The patient with a kidney tumor said, 'It all sounds like gobbledygook to me, but when you print it and put it in my hand, there's incredible power to understand,'" Amendola says.
Surgeons can effectively communicate what they want to do – or not do, Amendola adds. One patient with a cyst on her vein ultimately decided that she did not want to have the surgery, after holding the model.
The beginning of the 3D printing revolution
Amendola was drafted into the 3D printing world in 2021 by the head of 3D printing for the nationwide VA system, Beth Ripley, M.D., Ph.D. A 20-minute meeting about something else, as Amendola tells it, became a four-hour meeting about how he could help expand 3D printing technology across the VA – at the hospital level.
Amendola has led the charge for pre-surgical modeling at the CVHCS, helping make it a leading site for medical 3D printing nationally. The fellowship, funded by the VA and the Department of Defense, is a natural outgrowth of that charge. Amendola has a keen interest in making training a big part of his work, having earned a Master of Education in the Health Professions from Johns Hopkins University in 2019.
“We're at the very beginning of this – which is why teaching and studying it is so important at this stage,” he says. There are 3D printing fellowships in radiology, but this is the first in surgery.
One of the three inaugural fellows for 2021-22, Otoya enjoyed the program so much that she’s staying on for another year to help develop second-year curricula and advance the nascent field. The other two fellows, Sally Boyd, M.D., and Lucas Keller-Biehl, M.D., are continuing their research residency at VCU Health.
A 2019 graduate from the School of Medicine, Otoya benefited from a pair of scholarships during her time on the MCV Campus: the Dean’s Scholarship and the philanthropically funded Dorothy Velma Clark Loveall Scholarship.
"As a Latina, an immigrant and first in my family to go to medical school, these scholarships meant the world to me," Otoya says. "The financial support helped me focus on programs like the International/Inner City/Rural Preceptorship and spend more time in the community. I carry this with me in my surgical training and at the VA, where we see veterans who face issues like access inequality and socioeconomic disparities."
During her surgical residency at the VA, Otoya was intrigued by the 3D models in Amendola's office. A conference she attended with him introduced her to the full extent of the technology's potential.
"The value of these models – being able to show something, hold something, physically manipulate it – is incredibly valuable," she says. "It gave me a new perspective on how to problem solve and how to think of anatomy. Now when I look at a CT scan, my brain is slowly reprogramming it to view it in 3D."
The fellowship has given her one-on-one training in 3D printing pre-surgical models, from knowing what they need in a scan to working with engineers on post-processing. The fellows also field national requests for 3D models – all in addition to their regular clinical duties.
A big part of the training program is educating others, teaching their fellow doctors what is possible – and not possible – with 3D printing.
“You get requests that are not overtly appropriate,” Amendola says. “Then you'll get requests that are appropriate, but don't have appropriate imaging. We teach fellows how to ask surgeons, ‘What's the key clinical question that the model will solve?’”
Amendola adds that point-of-care printing at the hospital level is the future. It’s convenient, solution-focused and allows for iterative change on the designs. All providers and especially all surgeons, Amendola hopes, will one day have familiarity with 3D printing and its capabilities.
“We are at the beginning of a personalized medicine revolution,” Amendola says. “3D printing is a tool in that revolution, and surgeons are going to use it more and more.”