3D printing has made an exciting impact in the medical world—from being used for organ regeneration and pre-operative surgical planning, to research in tissue design and an advanced educational tool—its possibilities are endless. With the potential for innovative advancements in customized patient care and deeper abilities to showcase complex science and medicine, 3D printing is only building momentum.

Two Center for Reproductive Medicine members take us through their journey into 3D printing—depicting its uses in both male and female reproductive medicine, through the labs of Drs. Jennifer Dietrich1 and Richard Link2. Below we see their passion for 3D printing in gynecologic and urologic care, and how its power is shaping innovative research, advancing education for physicians, scientists and trainees and building personalized patient care.

Gynecology

3D Printing in Gynecology_Vaginal Dilators_Dr. Julie Hakim  (320x240)
Customized 3D printed vaginal dilators used to examine the biomechanical and bio-optical changes in porcine vaginal tissue after customized tissue stretching.

Julie Hakim, M.D.
Fellow, Pediatric Adolescent and Gynecology
Dr. Jennifer Dietrich1 Lab
Department of Obstetrics and Gynecology

Q: What do you think makes 3D printing unique in the field of gynecology?
A: There are a number of unmet clinical needs in the field of gynecology for which 3D printing is unique in its prototyping, customization and small-market production capabilities. In pediatric gynecology, we use vaginal stents post-surgical neovagina creation, in order to maintain the caliber of the newly created vagina and to avoid stenosis. Neovaginal creation is necessary in girls born with Mayer Rokitansky Kuster Hauser Syndrome (1/4500), Vaginal Agenesis (1/5000-7000), Complete Androgen Insensitivity (1/50,000), cloacal anomalies, Congenital Adrenal Hyperplasia and other congenital anomalies. 

Following stent use, most patients will need to transition to a vaginal dilator to maintain the vaginal patency. These may be used in women who have undergone extensive pelvic surgery, radiation for gynecologic cancer or scarring for disfiguring. Vaginal dilators may also be used for neovagina creation in patients with vaginal agenesis related to the above congenital conditions, who decline or who many not be surgery candidates. 

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3D printing is an excellent and affordable prototyping and medical design tool. This method is fast and accurate, despite the design complexity. It can substantially reduce the cost of iteration and innovation in the research and development of medical devices. 

Q: Aren't vaginal stents readily available?
A: Vaginal stents are no longer available in North America. Available vaginal dilators exist in larger sizes that cannot be used safely or comfortably in the pediatric population or in women with significant vaginal length shortening. By using 3D printing technology, customized vaginal stents and dilators can be created to improve functionality, fit and performance, specific to pediatric and adult populations. This would be the first patient-specific gynecologic device on the market. 

Q: Are you using 3D printing for other advances?
A: Dr. Jennifer Dietrich and I are leading a collaboration between Texas Children's Pediatric Medical Device Innovation Fund with biotechnology students at Texas A&M to produce a 3D printed Mechanical Leech to reduce venous congestion, scar tissue and improve graft neovascularization. 

Q: Have these initiatives been shared with patients?
A: All of our efforts are still in the research and development phase. We hope to leverage the knowledge and skills gained through 3D printing projects to translate to patient care one day. 

Urology

3D printed models of kidney cancer
Customized pre-surgical models of kidney cancer are generated for patients. This allows surgeons to operate on an identical tumor before operating on the patient. 

Jason Scovell
M.D., Ph.D. Student
Dr. Richard Link2 Lab
Department of Urology

Q: What do you think makes 3D printing unique in the field of urology?
A: 3D printing is an exciting field where many medical applications are still being developed. Currently the main applications of 3D printing in urology have been focused on pre-operative visualization and planning, surgical training and patient education.

Q: What are some current research initiatives Dr. Link's lab has applied 3D printing towards? 
A: In our lab we are utilizing two different printing technologies—both hard and soft models. Using hard models we can affordably and rapidly produce a variety of 3D printed kidneys which we are using to train medical students and residents on how to visualize CT imaging for kidney cancer. These models allow trainees the ability to touch and interact with a physical representation of the imaging which we believe will help with their understanding of anatomic relationships shown in standard patient imaging. 

We are also developing patient-specific soft 3D printed kidney models in conjunction with Jacques Zaneveld, Ph.D., President and Founder of Lazarus 3D, a Houston-based 3D printing technology company. These models can be surgically manipulated to perform a pre-operative rehearsal for difficult partial nephrectomy cases and for resident training. 

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This is a major advancement in surgical practice as we believe that it will allow for improved surgical decision making and decrease the learning curve for resident and fellow trainees. 

Q: Have these initiatives been shared with patients?
A: We have also shared these models with several patients, which have been met with very positive responses. The patients have remarked that it has helped them to better understand their disease and the treatment approach. 

Q: What are some goals or next steps?
A: We are pursuing prospective trials to improve a trainee's ability to understand clinical imaging and a trial to demonstrate patient-specific surgical model accuracy for pre-surgical rehearsal and practice. We hope that these trials will demonstrate the efficacy of these two tools. In the future, we hope to expand these modeling approaches to a broader group of trainees and integrate these models into standard resident training and practice. 

1Jennifer Dietrich, M.D., M.Sc., Chief of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Division Director of Pediatric and Adolescent Gynecology, Baylor College of Medicine, Associate Professor, Department of OB/GYN

2Richard Link, M.D., Ph.D., Associate Professor, Department of Urology

Interviewed by Jyoti Patel, Senior Project Coordinator, Center for Reproductive Medicine