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Статьи | Клиника Ихилов

First Print the Tumor — and Then Take It Out

​Three-dimensional printing is a technology that makes it possible to almost instantly create 3D models directly from engineering plans in a computer. It is gaining momentum in the medical world in general and in the surgical sphere in particular. By using computer software, two-dimensional diagnostic images from CT and MRI can be converted into three-dimensional images that are then printed three-dimensionally, providing a physical model of the organ in question.

08, Jan 2019

This technology is particularly significant in the field of orthopedic oncology. This field deals with many surgical challenges, the greatest of which is the high precision required to excise malignant bone tumor, which must be completely removed from the bone in order to prevent a relapse and metastases.

The precise planning of tumor removal is even more important when it comes to children – the main population affected by bone tumors; since their bones are still growing. Similarly, total removal of bone tumors located near joints and growth plates is a very difficult surgical proposition. In these and other cases, the technology enables the construction of a 3D model of the organ, complete with the bone and the tumor, so that the location of the tumor and its exact boundaries can be assessed and the removal planned with maximum precision. This reduces the chances of a relapse and increases the chances of preserving the joint and growth plates among children.

We are currently conducting a research project at Tel Aviv Sourasky Medical Center (Ichilov) in partnership with Imperial College London. The project is for patients suffering from primary bone cancer (sarcoma) with emphasis on children aged five to eighteen. The clinical application of the project, which was recognized by the Israel Cancer Association, is taking place in the National Orthopedic Oncology Department at Ichilov Hospital.  The project involves developing unique computer software that renders a complete three-dimensional image of the tumor, from which a three-dimensional plastic model of the bone containing it can be printed.

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The surgeon can sketch the incisions upon the computer image and print them so that he can practice the procedure before the actual removal. The software also uses the surgeon’s incision sketches to construct a PSI (patient-specific instrument) that matches the bone surface. The PSI is also printed three-dimensionally and is placed inside the body during the operation to define the boundaries of the tumor.

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In addition to sketching the tumor’s boundaries for precise removal, the pre-surgery planning allows us to identify, in advance, obstacles that could interfere with the operation (for example, blood vessels and nerves adjacent to the tumor or in its vicinity). Consequently, it reduces the range of human surgical errors, mainly in complex anatomical regions such as the pelvis. Another goal of the project is to develop advanced implants for bone reconstruction once the tumor has been removed.

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Today, bone reconstruction is performed using standard metal implants or bone transplants, and we are looking into the development of patient-specific implants, to be printed from metals or innovative biological materials.It should be noted that three-dimensional technology is also being used in regular orthopedic surgery. Thus far, several successful surgeries on patients suffering from bone tumors have been completed as part of the project’s clinical application stage, and we hope that we will be able to help many more patients in the future.  Dr. Solomon Dadia, a senior physician in orthopedic oncology at the Tel Aviv Medical Center, is currently directing the research project on three-dimensional printing of bone tumors at Imperial College London.

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