Realistic 3D printed chest models for surgical training

Realistic 3D printed chest models for surgical training

At MEDICA 2022, NewsMedical spoke with Heike and Thorsten Walles, co-founders of MD2B LifeScience, which provides realistic chest models for surgical and implant training. These 3D printed models could revolutionize the approach to training, with replaceable ribs that replicate the behavior of real human bones.

Can you introduce yourself and your professional background?

Heike Walles (HW): My name is Heike Walles. I am a biologist and have worked for 25 years in the field of tissue engineering. I have a lot of experience in how you can combine materials with cells to create tissue specific models.

Thorsten Walles (TW): My name is Thorsten Walles. I am a surgeon specializing in thoracic surgery, and I am a professor of thoracic surgery at the University of Magdeburg where I train young doctors. I am also involved in training programs with our National Society of Thoracic Surgery.

MD2B LifeScience is a spin-out from the University of Magdeburg that creates 3D printed thorax models for medical training and surgical planning. What inspired you to look for a chest modeling solution?

TW: It all started with robotic surgery. When we use robotics, the surgical procedures are very standardized, but I wanted to do a non-standardized approach for a rare tumor and had the problem of how I could rearrange the robotic framework for my patient. At the time, I wish there was some kind of training device to play around with how to plan surgery a bit, but unfortunately there wasn’t. So I did the surgery with no training, and it was fine, but that kickstarted the idea where it all started.

Image Credit: MD2B LifeScience

I asked the engineering department at our university if it would be possible to generate 3D models of the thorax, and the engineers told me they could do it.

How was the process of developing your chest models and how have they evolved since your first ideas?

TW: It turned out that technically there were challenges that the engineers had to solve, which they did, then the idea continued, so we decided to create a model to train young doctors and even professionals like me for complicated surgeries.

We presented our idea in September 2021 at a national medical congress, and then other doctors came up with additional ideas. Then some industry representatives remarked, “Well, you’ve got the chest and you’ve got the chest bones; it is useful for our implants”. They realized they could use the models to practice applying implants or modifying implants. And so the idea just kept growing.

Image Credit: Magdeburg University Hospital

HW: Currently, for much surgical training, animals are used. If you come from the field of tissue engineering, you are experienced in creating alternatives to animal models that perform the same functions. In our new development, we are therefore implementing this goal. First, we have a realistic copy of the human rib cage that surgeons can practice with, and second, we can insert bioartificial human tissue, for example lung tumors.

For image-guided interventions, universities and industry are developing electrodes and other devices for chest operations. Many of these devices must be usable in the context of TRMs. That’s why we modified our material so that you can use it under MRT.

With further ideas from our shareholders and scientific partners, we continue to develop our product and our business. At MEDICA, our development has already won over various representatives from academia and industry.

What materials are used in the thorax models?

HW: We really focus on the material so that the model ribs have the physiological behavior of human ribs. That’s why the industry can optimize their implants with them, because they break and act just like human bones. For training purposes, it is much less expensive to work with a standard model, but if someone is interested in an individualized patient-specific chest model, it is possible to create one from the CT data.

Image Credit: Magdeburg University Hospital

We have applied for material patents. Bone structures are generated from modified polymers. Bioartificial human tissues are based on collagen compounds.

Why is there a need for better models of the thorax specifically?

TW: In minimally invasive chest surgery operations, the patient lies on their side. The anesthetist caring for the patient will block the upper lung so that it deflates and collapses. As a result, a cavity forms between the chest wall and the collapsed lung. The surgeon enters this space with his instruments and does what he has to do to perform the operation. Sometimes he has to turn the lung from back to front to reach the posterior surface or vice versa.

Image Credit: Magdeburg University Hospital

The challenge is to perform these operative maneuvers in the restricted space of the thoracic cavity. There are different training models to perform minimally invasive operations of the pelvis and abdomen; Compared to the actual situation in the chest, these models allow great freedom to perform the operations.

HW: We cover our training models with a layer of soft fabrics that we have developed so that you cannot see inside. Trainee doctors really need to learn how to access the rib cage and practice feeling the ribs. In order to create realistic operating conditions, animal organs can be placed in our training model, for example. Organs can also be perfused and ventilated.

What is the point of printing the ribs in 3D?

HW: Our additive production approach enables the anatomically correct imitation of the anatomical structure of the ribs by mapping both cortical parts and the medullary cavity for the first time. Moreover, a rib is not a harmoniously curved bone with an oval section but changes its shape several times during the anatomy.

Several healthcare companies that provide implants for rib reattachment have tested our preliminary designs and have begun using them to train physicians and medical users on how to apply their implants.

After surgical or implant training, if a rib is broken, it can be exchanged easily, and it can be broken again in another position if necessary.

How do these models help reduce the need for animals in surgical training?

TW: The exact anatomical representation of the human thoracic skeleton provides a more realistic training environment than many established animal models. Fresh or commercially available animal organs can be used for realistic representation of visceral surgical steps, but in all cases this model reduces the need for laboratory animals. No special room is required for the use of our training models; in this way, a training stand can be made from any desk or seminar workstation.

Image Credit: Magdeburg University Hospital

We started using our model also for student training because every young doctor has to learn how to insert a chest tube. Compared to the effort of having to get an animal carcass from the slaughterhouse, our model is much easier to organize and handle.

Why is it important that your models show up in MRIs and CT scans?

TW: This functionality is not necessary for surgeons, but we have in mind that we could use our model to train interventional radiologists. For example, minimally invasive procedures on the chest, such as percutaneous nodule biopsy or radiofrequency ablations, can be trained.

How important are shows like MEDICA in promoting new innovations like yours?

HW: For us as a small and young spin-off, it was really very important. We wanted to know if our development appealed to user groups, and to do that, I think it’s very important to have companies like this.

Image Credit: MD2B LifeScience

TW: We are still at the beginning of development and we can go in different directions. As a small start-up, we have to decide what makes the most sense and what’s next. At MEDICA, we receive feedback from professionals, potential future customers or other academics. MEDICA helps us develop an idea of ​​what the market wants.

HW: It’s really fantastic to discover that your idea is relevant.

Are there clear and immediate next steps you will take to improve your current models?

HW: We will focus on finalizing the soft tissue coverage. Next, we will need to implement models for the visceral organs of the thorax.

TW: Is it the chest and rib cage itself that most people care about? Or do we have to try harder to come up with an idea for internal organs like heart and lungs? Is it enough to remove organs from slaughtered animals or do we need artificial organs made of silicone, plastic, etc.? ? There are already products on the market, but we have the idea of ​​representing the haptics of the organs to give the user a realistic experience during his training and his interventions. So the question is: how close can we get to the artificial technologies we currently have?

About Heike Walles and Thorsten Walles

Heike Walles, doctorate Born in 1962 in Germany. 1982 – 1988 Studies in biology at the Justus-Liebig-University Gießen, Germany. 1989 – 1994 Doctoral thesis at the Ludwig-Maximilians University of Munich1999 – 2003 Post-Doc and junior professor at the Leibniz-Research-Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Hannover. 2004 – 2012 Head of Cellular Systems Department, Fraunhofer-Institut Interfacial Engineering and Biotechnology (IGB), Stuttgart. 2009 – 2018 Full Professor of Tissue Engineering and Regenerative Medicine, Julius-Maximilians-University, Würzburg. 2014-2018 Head of the Fraunhofer Translational Center for Regenerative Therapies in Oncology and Musculoskeletal Diseases, Würzburg. Since 2018 Head of Core-Facility Tissue-Engineering, Otto-von-Guericke-University, Magdeburg, Germany. 2011 Co-founder of TissUse GmbH (Berlin). 2022 Co-founder of MD2B LifeSciences GmbH (Magdeburg).

Thorsten Walles, MD FETCS. Born in 1972 in Germany. 1993-2000 Studied medicine at the Hanover Medical School. 1997-1998 Research stay at Johns Hopkins University (Baltimore, USA). 2000-2009 Clinical training in cardiac, thoracic and vascular surgery as well as in general surgery. 2009 specialist in thoracic surgery. Since 2017 Professor of Thoracic Surgery and Head of Department of Thoracic Surgery at Magdeburg University Hospital. Focus: oncological surgery, minimally invasive thoracic surgery including robot-assisted surgery, pediatric thoracic surgery, thoracic traumatology. 2011 Co-founder of TissUse Gmbh (Berlin). 2022 Co-founder of MD2B LifeSciences GmbH (Magdeburg).

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