Will 3D printers, bioprinters change the future of surgery?

3D printers help doctors practice complicated surgeries, create bespoke prosthetics and even print spare body parts for implants. Now doctors are turning to bioprinters to 3D print human tissues and, eventually, organs for surgeries of the future.

Bioprinted organs would not look like those studied in anatomy books

Scientists are working towards bioprinting an organ that can be transplanted into a human body at the Wake Forest Institute for Regenerative Medicine. (Wake Forest Institute for Regenerative Medicine)

When an MRI revealed a golf ball-sized tumour growing in Pamela Shavaun Scott's skull, the California psychotherapist turned to a 3D printer to help find the least invasive and risky way for doctors to extract it.

Her husband, Michael Balzer, the founder of a 3D printing service company, used her medical records to create a three-dimensional image of her brain on his computer and print a 3D model of it.

"I could see literally, in pretty good detail, my wife and the inside of her head — more importantly, the tumour itself," says Balzer.

Doctors used his images and printout to help determine how best to surgically remove the tumour. They removed 95 per cent of it last May, deciding that the remainder was too close to the optic nerve of her left eye to risk cutting into.

California residents Michael Balzer, left, and Pamela Shavaun Scott, right, hold the 3D printed model of her skull that helped doctors determine the best way to remove a golf-ball sized tumour behind her left eye. (Michael Balzer)

At the hospital, several residents approached Balzer, excited about the potential of using 3D models as teaching aids. "There was a little bit of buzz," he admits.

At some hospitals, doctors regularly study 3D models to diagnose maladies or practice complicated surgeries.

But these futuristic printers can be more than a teaching aid, they've become a hotbed of medical solutions to complex patient problems. 

In fact, scientists have been frantically printing customized prostheses and implants from head (skull implant) to toe (titanium heel implant).

The advent of bioprinters — which use what is called bioink made of replica human tissue — have upped the 3D printing game. Now, the race is on to create the first bioprinted organ and transplant it inside a human body.

3D printed scalpels act like a 'cookie cutter'

Doctor Frank Rybicki started using 3D models while working on patients with severe facial injuries, such as an Afghanistan war veteran who had a piece of bone from a leg reconstructed into a new jaw at the Brigham and Women's Hospital in Boston, Mass.

"If you 3D-printed the patient before the surgery, you could really understand what you needed to do because you would be able to hold the defect in your hands as opposed to just looking at a picture of it," he says. 

Frank Rybicki has used 3D printed models to prepare for surgeries on patients with complex facial injuries. (Radiological Society of North America)

Not only that, the printout helps patients better understand what's wrong with them and how their doctor will attempt to remedy it. Plus, doctors can practice a surgery on the model before heading into the operating room.

Rybicki doesn't just print models. He's also printed scalpels shaped to make the exact cut needed to grab skin from a patient's buttocks or leg and transplant it onto a face.

"You get these amazing results, because all the tissues match up because you 3D-printed the cookie cutter."

Rybicki, who's the incoming chief of medical imaging at the Ottawa Hospital and chair of radiology at the University of Ottawa, is advocating for a national 3D printing lab there because he believes the technology is "enormously helpful."

Tissues, tumours bioprinted for experiments

He finds one of the most exciting development is the almost "Star Wars"-like field of bioprinting, like when San Diego-based Organovo last year unveiled a 3D bioprinted human liver tissue for scientific research. 

Organovo hopes the printed liver will lead to the development of better, safer drugs faster and less expensively than when only animal and human testing was possible, says Michael Renard, the company's executive vice-president of commercial operations.

At the moment, only liver tissue is available for testing, but the company expects to release other printed tissue, including kidney, skin, lung and blood vessel as well as bone, Renard says.

Organovo has also built tumours for scientists to experiment on, allowing for "interesting experiments" that couldn't ethically be conducted if the tumour was inside a person's body.

Another team of scientists at the company is attempting to develop tissues that could be transplanted into a real patient.

This bioprinted kidney or liver likely wouldn't resemble the images people are used to seeing in anatomy books, Renard explains.

"Restoring, you know, kidney function to someone who's really failing doesn't require two perfectly architected human kidneys to do that," he says.

The bioprinted tissue would have to restore the original organ's lost functionality, he says. That could be achieved through "some form of patch," made of tissue that could be implanted to assist the failing area.

'No. 1' goal is bioprinted organ

In a lab in Winston-Salem, N.C., scientists have already grown a whole vaginal organ that was later transplanted into a patient who was born without one.

Anthony Atala says the No. 1 goal of scientists at the Wake Forest Institute for Regenerative Medicine is to create an organ that can be transplanted into a human. (Wake Forest Institute for Regenerative Medicine)

The Wake Forest Institute of Regenerative Medicine's scientists built that organ by hand. But they have been experimenting with bioprinters for more than a decade to speed up the creation process, says the lab's director, Dr. Anthony Atala

Easily producible spare kidneys, lungs and hearts could speed up lengthy wait times for patients on organ donation lists.

At Wake Forest, scientists have been working on about 30 different types of tissues and organs, Atala says, from the simplest flat structures, such as skin, to the most complex organs, such as "miniature livers and hearts."

So far, bioprinting organs to transplant into humans has been unsuccessful, and Atala says it's hard to predict when scientists will make the breakthrough.

Solid organs are incredibly complex with many more cells per centimetre than skin, one of the simpler structures that has been created. For organs, doctors must be able to make blood vessels capable of keeping blood flowing to them.

Despite the challenges, Atala's commitment seems unshakeable. Printing organs, he says, "is the number one thing that we're trying to get to."


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