3-D printed kidney used in complex cancer surgery

3-D printed kidney used in complex cancer surgery

(Scott G. Winterton, Deseret News)


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MURRAY — Not every tumor patient goes home with a plastic 3-D model of their own malignant organ, but Linda Green is a special case.

"This is the part that scared me the most," she said, pointing to the small, black mass representing the tumor on the model kidney.

Green developed the tumor in 2008, but doctors were more concerned with a separate tumor on one of her ovaries at the time. Since the cancer on her kidney wasn't growing, doctors decided to let it be and watch it.

In 2016, Green learned the kidney tumor had more than doubled in size. It was centered at the top of her kidney, dangerously caught in branches of arteries, veins and the kidney's drainage system.

Her husband, Dennis Green, said he expected doctors to remove the kidney.

"I fully thought that's what would end up happening," he said.

Dr. Jay Bishoff, director of the Intermountain Urological Institute, had a better idea.

The model

After meeting with the Greens, Bishoff recognized the operation would be difficult, he said.

"Tumors on the edge of the kidney are very easy to take care of," the doctor said. "It’s the tumors entangled with essentially the business part of the kidney is where the risks go up."

Bishoff was approached by specialists with Intermountain's Healthcare Transformation Lab who asked if he had a "complex case" they could use to create a 3-D model.

Jay Bishoff points to a 3-D model of Linda Green's kidney during a press conference at Intermountain Medical Center in Murray on Monday, June 20, 2016. (Photo: Scott G Winterton, Deseret News)
Jay Bishoff points to a 3-D model of Linda Green's kidney during a press conference at Intermountain Medical Center in Murray on Monday, June 20, 2016. (Photo: Scott G Winterton, Deseret News)

"I said, 'Absolutely,'" Bishoff said. "As physicians, we are constantly scouring for evidence-based new technology to figure out what else can we do above and beyond what we're already doing for our patients."

Collaborating with multiple departments at Intermountain Medical Center, Healthcare Transformation Lab specialists took raw images from Linda Green's CT scan and converted the images into a 3-D model. Using 3-D printers, lab workers created an exact replica of the cancerous kidney.

"There are challenges in actually converting the CT scan into a model," said Cory Smith, a Healthcare Transformation Lab specialist. "The important part of this is the discussion about what the model should look like, what types of materials will work."

The lab had printed 3-D models in two previous medical cases, but Linda Green's 3-D kidney model was the first created in advance of surgery.

"(The tumor is) nestled in the least opportune place that you could possibly have a tumor on a kidney," Bishoff said. "Without the 3-D reconstruction, it would’ve been extremely difficult for us to communicate to Mr. and Mrs. Green the complex nature of what we were doing."

The Healthcare Transformation Lab printed a number of plastic models of the malignant organ for doctors to look at. Tissues of the kidney were colored white, arteries and veins were blue, and cancer was a mass of black near the top.

While studying the tumor, Bishoff said he found a tiny "peak" of the tumor that surgeons had not seen in the CT scans.

"Without the 3-D reconstructed model, we would’ve had a difficult time appreciating that we needed to get that piece out as well," he said.

The surgery

Intermountain Medical Center operates on about 150 kidneys a year, Bishoff estimated. Linda Green went into surgery on May 18.

In the operating room, surgeons used a glass model of her kidney as a guide.

"The clear glass allows us to see inside of the kidney, whereas a traditional kidney you wouldn’t be able to see the internal works of it," Smith said.

The glass kidney model was printed in halves so surgeons could examine the inside portions.

Dennis Green, left, and his wife, Linda, Jay Bishoff, director of the Intermountain Urological Institute, and Cory Smith, a Healthcare Transformation Lab specialist, speak during a press conference at Intermountain Medical Center in Murray on Monday, June 20, 2016. (Photo: Scott G Winterton, Deseret News)
Dennis Green, left, and his wife, Linda, Jay Bishoff, director of the Intermountain Urological Institute, and Cory Smith, a Healthcare Transformation Lab specialist, speak during a press conference at Intermountain Medical Center in Murray on Monday, June 20, 2016. (Photo: Scott G Winterton, Deseret News)

"This is very exciting that I have a road map that I can use for planning," Bishoff said. "How exciting that now it's 2016, and we have an opportunity to mesh technologies in such a seamless and important way."

Using the model, he said the operation was fairly short with no significant bleeding. The tumor was completely removed, leaving the kidney fully intact.

Linda Green was released from the hospital the day after the operation. By the following Monday, she was back to baby-sitting her 2-year-old grandchild.

Bishoff gave Linda Green one of the plastic models of her kidney as a gift at a news conference Monday.

"To think my kidney looks like this," she said, holding the model and laughing.

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