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3D Unit

The 3D Unit consolidates the planning and simulation of complex surgery and serves all paediatric specialties

In 2013, SJD Barcelona Children's Hospital planned the first-ever complex oncological surgical procedure using three-dimensional printing for a paediatric patient. Since then, the number of surgical specialties using this technology to plan or guide surgery has multiplied. Currently, nine surgical specialties at the hospital use this type of technique to treat our patients (Orthopaedics and Traumatology, Maxillofacial Surgery, general and thoracic Plastic Surgery, Dentistry and Orthodontics, Oncology, Foetal Medicine, Neurology and Cardiology). The 3D Unit, a pioneer in Spain, has since been consolidated and offers solutions to all Departments and Units that request planning or use new technologies to improve the performance and safety of surgeries and other procedures. This Unit has received a license from the Generalitat de Catalunya as custom manufacturer of medical devices.

Mixed model and interdisciplinary study of cases

Professionals specialised in 3D planning and printing work under a mixed work model in a specific unit in the hospital itself. Here, virtual simulations and planning are done, anatomical models are printed and cutting and positioning guides are prepared. We also have an external team of professionals and suppliers who assist in more complex cases and custom implants. This model facilitates a more efficient and effective service to clinical teams and meets any planning challenges that may arise.

The cross-cutting, multidisciplinary team is coordinated by the Innovation Department and is made up of engineering experts, members of the Diagnostic Imaging Department, Surgery, the innovation, and biomedical engineering team, finance, and the Darwin Advanced Simulation Programme team. In addition, the hospital belongs to the Carlos III Health Institute (ISCIII) Biobanks and Biomodels Platform. The members of the unit study each case and assess the possibilities and clinical benefits to the patient of applying 3D techniques. 

Clinical applications of 3D technology

Virtual surgical planning

Planning (before and during surgery) allows the surgical approach to be simulated and tested, which is personalized and adapted to each individual patient. This achieves better outcomes and reduces surgery time.

Cutting and positioning guides

In Maxillofacial Surgery and Orthopaedics and Traumatology, custom parts can be designed to guide the cuts and movements planned for surgery. This facilitates surgical precision and improves times and outcomes.

It is not covered by public health

Anatomical model printing

Life-size 3D modelling of tumours, organs and bones for use in medical training and research. The parts can be used by surgeons to prepare and explain surgery to families or to personalise osteosynthesis material.

It is not covered by public health

Prostheses and orthosis prototyping

3D manufacturing makes it possible to offer solutions to children with mobility issues and amputations. Orthoses are normally used for rehabilitation and musculoskeletal correction.

It is not covered by public health

Teaching and simulation

3D models are used in teaching activities to simulate complex cases. Simulation and moulding techniques can be combined with 3D techniques to produce custom phantom models and simulators. We belong to the Expert3D training programme.

Research

The 3D Unit is participating in 4 European projects, including QuirofAM and Base3D (Fuse3D). During the pandemic, SJD Barcelona Children's Hospital also participated in the CAR3D project (https://car3d-project.eu/) to fight COVID-19.

Advantages of 3D planning and printing

Process standardisation

A healthcare pathway has been established for all clinical departments in order to implement agile and optimized surgery planning processes. Cumulative experience in complex cases enables techniques that can be repeated in the same disease to be applied and consolidated. For its part, standardization represents an improvement in process efficiency and offers tools available to surgeries such as physeal bridge resection, planning of surgeries for Pierre Robin syndrome, plastic surgery for cases of microtia, autologous tooth transplantation, and alveolar cleft correction.

Safety

Reduction in ischaemia and anaesthesia time and fewer complications thanks to simulations and surgical rehearsals. Surgical rehearsals allow for a very high degree of precision and anticipation of possible difficulties in the operating theatre. The Maxillofacial Surgery team has treated more than 200 dental and facial deformations using planning with 3D technology. The Oncological Surgery team has handled 8 cases of neuroblastoma and the Neurosurgery team has performed a lateral craniosynostosis correction surgery.

Efficiency and efficacy

Planning reduces surgery time, thereby enabling faster patient recovery and reducing resource use and costs. For alveolar cleft reconstruction and pinna reconstruction, surgery times are reduced by up to 40%.

Outcomes and quality

Precision and improved outcomes

By applying a high-precision approach, the planned outcome is achieved in practically all cases, while also reducing repeat surgery rates. 

Better experience

This technology helps patients and families better understand the surgical procedure for treating the disease.

Facilitation of clinical learning

Application in medical resident training. Practice in mandibular distraction techniques where 3D helps to standardize the surgery.

3D unit figures

Yearly average of
200
cases planned in 3D
Specialties
9
use 3D planning
Reduced surgery time by up to
40%
in certain cases
Publications
+16
since 2014

SJD Barcelona Children's Hospital 3D Unit team

Cases treated in the 3D Unit

3D planning technology enables surgeons to better anticipate what they are going to find and plan accordingly. With this, the professional can rehearse the surgery and improve its safety.
Lucas Krauel, paediatric surgeon at the SJD Barcelona Children's Hospital
This maxillofacial surgery technique planned with 3D technology will become the standard in most countries in the medium term.
Josep Rubio, maxillofacial surgeon at the SJD Barcelona Children's Hospital
A prosthesis planned with 3D technology has allowed the recovery of a patient with a severe cranial tumor.

ISCIII Biomedicine and Health Sciences R&D&I support platform. Biomodels - 3D Printing, Project Code PT20/00090, funded by the Instituto de Salud Carlos III, aid programme for ISCIII Biomedicine and Health Sciences R&D&I support platforms from Strategic Action in Health 2017-2020 and co-funded by the European Union through the European Regional Development Fund and the European Social Fund.

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