The integration of 3D printing in the hospital environment

Over the years, 3D printing has gradually established itself in the medical field. Orthopaedics, ophthalmology, dental or even traumatology, there are many specialties that today use technology to optimize their activities. And for good reason. Due to its characteristics, additive manufacturing makes it possible to design all types of applications quickly and at a lower cost. Medicines, insoles, orthoses, prostheses, surgical guides. There are countless use cases for additive manufacturing in the health sector. But while more and more initiatives are emerging, what about the integration of 3D printing in hospitals? Between advantages, challenges and limits, 3Dnatives comes back for you on the question, still subject to many debates among professionals, patients, but also the general public.

Several years ago, additive manufacturing was introduced in hospitals, in several countries. In the United States, for example, the organization Statista, producing statistics on various topics, identified in 2010 only 3 hospitals with internal 3D printing facilities compared to 113 in 2019. A dazzling increase, which testifies to the interest of the medical profession granted to technology. On the other side of the Atlantic, in France in particular, additive manufacturing is also gaining popularity in university hospitals, particularly near Brest and Besançon. There, technology is deployed for various reasons, whether to help practitioners in their therapeutic choices or to allow patients to better understand their pathologies.

The 3D printers of the I3DM platform of the CHU of Besançon (Photo credits: CHU of Besançon)

Hospital 3D printing: various uses

Between operating time savings, development of personalized surgery and low-cost manufacturing, I see few limits to technology in the hospital environment. That’s why I believe in it so much says Samuel Guigo, radio manipulator and in charge of 3D printers at Brest University Hospital. Like many, the practitioner is seduced by the advantages offered by technology. Because like the many industries that use 3D printing, additive manufacturing is used for a variety of purposes in healthcare facilities. And in the hospital environment, the main use is probably the creation of surgical guides. Aurélien Louvrier, maxillofacial surgeon at the Besançon University Hospital, explains: “ This makes it possible to be reassured and to consider in a more serene way surgical interventions which seem at first sight quite complex. The surgery is already performed virtually, we arrive at the operating room with less apprehension. Thanks to the surgical planning carried out virtually and the 3D printing of anatomical models, it is possible to perfect the analysis of each case and to consider different operating strategies. Once you have chosen the most suitable solution, you can proceed calmly to the act. Many surgeons at the CHU de Besançon have adopted this technology. Created in January 2020, the I3DM platform currently performs around 150 planning and 3D printing per year. »

If the printing of 3D models allows practitioners to better understand the anatomy and pathologies, it also allows patients to better understand what they are suffering from. Indeed, with a physical representation of the pathology, the nursing staff is able to concretely present to the patients what the problems are and how they will proceed to try to fix them. In Barcelona, ​​for example, at the Sant Joan de Déu pediatric hospital, the surgical team, using BCN3D solutions, managed to remove a tumor in the cheekbone of an 11-year-old boy. A perilous operation which was facilitated by the planning and simulation of the surgical act. Proof that this application reassures both surgeons and patients, and helps to improve the patient/practitioner relationship. But summarizing the interest of additive manufacturing in the hospital environment for this purpose would be too simplistic.

3D printing hospital

3D printed reproduction of the child’s tumor. (Photo credits: SJD Barcelona Hospital)

Many benefits

As mentioned above, technology offers practitioners the opportunity to practice before performing an operation. And this training logically leads to a reduction in costs for healthcare establishments. The various surgeons who use 3D printed surgical guides explain that this application makes it possible to reduce operating time while improving precision, thereby reducing bleeding, the risk of infection and even the number of surgical revisions. A very important fact for healthcare establishments, the operating room being one of the biggest expenses for hospitals. Dr. Louvrier specifies: “ It’s really win-win, while improving the precision of the surgical gesture, it allows to reduce the operating time. We do not create financial benefits but we save money, if we save an hour of operating time, the economy is already made. »

Additive manufacturing in hospitals also promotes the development of new therapeutic approaches. Although most of the time they are only considered as healthcare establishments, university hospitals are also places that place great emphasis on research. Thanks to the capabilities of 3D printing, allowing for example to design custom-made medical devices, such as prostheses and orthoses, or drugs, many scientists hope in the coming years to be able to offer more patient-friendly care. However, to do this, certain conditions are necessary.

During the first wave of Covid-19, the AP-HP had installed no less than 60 3D printers. (Photo credits: LP/Olivier Arandel)

A growing ecosystem

As one might suspect, in order for 3D printing to be properly integrated into the hospital environment, it has to be a school project. Indeed, it is only when the management decides to invest fully that a 3D technology service can emerge. Mr. Louvrier returns to the beginnings of 3D printing at the Besançon University Hospital: “ We noticed that many teams were using 3D technologies, but each on its own. It was therefore proposed to management to centralize this activity by complying with standards from a regulatory point of view. » Following this, the hospital devoted itself to the creation of premises and to equipping itself with dedicated equipment respecting the standards allowing the design of medical devices. Since then, Ultimaker and Formlabs 3D printers have been used daily to help practitioners. To take care of it, a full-time hospital engineer is dedicated to this activity.

Obviously, integrating technologies such as selective laser sintering or even traditional manufacturing methods is much more complicated for a hospital. Indeed, this type of process requires premises that comply with many standards, representing too high a cost for healthcare establishments. This is why, when an implantable part, such as a custom-made plate or implant, is needed, hospitals turn to manufacturers. And even if third-party intervention is mandatory, the manufacturing process is faster. The practitioners and the hospital engineer can model the medical device themselves, and they send the 3D file to the partner company in charge of the design. Thanks to this new hybrid workflow, it is possible to obtain a personalized and tailor-made medical device more quickly.

Hospitals also call on external companies (photo credits: F3DF)

Limits to the integration of 3D printing in the hospital environment

If 3D printing is not integrated into all hospitals today, it is because certain obstacles are still present today. Slightly discussed before, regulation is the main challenge facing additive manufacturing. Mr. Guigo explains: The regulatory aspect and the ability of hospitals to produce their own medical devices in a certified manner are among the main limitations. We could also cite the fact of ourselves designing, printing and implanting a printed medical device, surely in my eyes the evolution towards which we must aim. »

At the same time, training in 3D technologies is also an obstacle to the total democratization of 3D printing. Currently, too few caregivers have the opportunity to take training in 3D technologies. It is for this reason that, still in Besançon, within the University of Burgundy Franche-Comté, a University Diploma (DU) was created in 2020 to overcome this problem. Entitled “DU I3DC”, for 3D Printing in Surgery, this course includes theoretical courses, intended to explain the different regulations, and practical courses, where students learn to model and print parts in 3D. Open to engineers and caregivers, this DU aims to generalize technology in the hospital environment but also liberal.

Towards a democratization of technology in the hospital?

And if additive manufacturing as we know it is spreading little by little, bio-printing is also starting to make its way into university hospitals. In Marseille, the French company Poietis, an expert in the development of bio-printing solutions, announced a new partnership with the Laboratory of Cell Culture and Therapy (LCTC). Together, the two companies aim to provide the AP-HM, Assistance Publique – Hôpitaux de Marseille, with a platform for designing implantable biological tissues.

Eventually, there is a good chance that technologies will become commonplace in hospitals. Due to its advantages, particularly in terms of cost and speed, the potential of 3D technologies in the hospital environment seems immense. Barely a year ago, Samuel Guigo confided on this subject ” not yet having an idea of ​​all the possible uses of printing in the hospital sector. »

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*Cover photo credits: Formlabs

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