The hospital in Cadiz has a laboratory where exact replicas of organs or bone fractures are produced.

This printing of biomedical material allows healthcare professionals to better analyze clinical cases, especially surgeries, which they can approach with greater confidence thanks to these economical reproductions.

Technological advances are making their way into various areas that influence our daily lives, and the healthcare sector is no exception. In Cádiz, the Hospital Universitario Puerta del Mar a good example of this thanks to 3D printing.

In a laboratory strategically located in the heart of the hospital, in the central area of the fifth floor, six machines are creating, layer by layer, elements that are of great help to many patients, even though they are unaware of it.

Thanks to this technology, this leading hospital is able to create exact replicas of parts of the human body, tailor-made from diagnostic tests such as CT scans or MRIs, which medical professionals can use to plan surgical procedures with a much higher level of detail. Among other things, this offers a high degree of safety during operations and also greater speed when carrying them out, thereby reducing waiting lists.

Dr. Pablo Andrés Cano, a specialist in orthopedic surgery and traumatology, is in charge of a service that is here to stay and aims to provide tools that facilitate the work of doctors and optimize patient outcomes. "It's a factory within the hospital," he says as he shows us around the room.

For this technical project, which began in 2017 and has gained greater relevance and official status with the creation of the Hospital Commission for Surgical Planning and 3D Printing, collaboration between medical staff and bioengineers, who use software to shape the designs, is essential. This paradigm, for which there is no turning back and which will evolve by leaps and bounds as the years go by, involves the integration of engineers in hospitals.

Among other professionals at the Cadiz laboratory is engineer Laura Galán, who never imagined working in a hospital while she was studying for her degree: "This is where I've learned everything because I didn't know anything about medicine. And I'll continue learning," she says.

This symbiosis, which results in improved healthcare quality, is made possible thanks to the participation of Cádiz Institute for Biomedical Research and Innovation (INiBICA) in various Projects collaborations with universities and companies around the world. In Laura's specific case, she was hired through the Investigo program of the Regional Government of Andalusia, which is financed with European funds.

The first thing that comes to mind when you see 3D printing machines is prosthetics and implants, but for now that will have to wait, explains the doctor: "There is a European regulation that will be published in 2017, and a Royal Decree of 2023, which regulates customized medical devices. They have different levels of safety; the biomodels we use are not the same as an implant that will remain inside the patient."

"That requires greater safety and is done in a factory's clean room. The hospital could have it, but right now it's not profitable, so companies are used," says Andrés. "What are we trying to do? Well, we want the entire process, except for the implant, to be done here at the hospital," he adds.

In the laboratory, they create surgical guides that are extremely useful for surgeons during operations. "The customized guides mark different areas of the bone that need to be operated on and show us where the injury is, which would be very difficult to do by eye," explains the surgeon.

The 'copies' of injured bones that they print allow orthopedic surgeons to 'rehearse' and plan the procedures they will subsequently perform on patients, which translates into greater safety, foresight, and shorter execution times: "It's an advantage while preparing for surgery." "The results are improved because you are better prepared, and therefore it is better for the healthcare sector because there are more guarantees and safer conditions for the patient," says the doctor. "Surgery must be performed according to an established plan; there is no room for improvisation," he adds emphatically.

And he puffs out his chest when he gives an overall assessment of the service: "We should be proud of our universal healthcare system, of the scientific level and quality of the professionals who work in public healthcare, and this line of research is a very important added value."

"Surgeons in Cádiz Spain have nothing to envy those in the United States, Germany, or China. The thing is, they may have an engineer closer at hand. But that is now changing," he says.

Engineers at the hospital:

"This is an artery," Laura points out, showing one of the printing machines. Some of these materials, made from different types of plastic, are destined for medical and nursing schools, where their characteristics can be studied in great detail.

It is precisely this integration into medicine that offers engineers a new field in which to specialize and work. "We didn't see any medical applications during our studies," says the engineer, who is satisfied with the work she is doing at Puerta del Mar and the knowledge she is acquiring.

Dr. Andrés explains that more than 30 engineers and students have already participated in this program, receiving training in the field and, conversely, teaching healthcare professionals certain technical matters: "They have come from all over Spain and also from countries such as Chile, Belgium, Venezuela, and England."

"What does it mean to be treated by a bioengineer? It means that your surgery and health problem will be treated from a more multidisciplinary perspective, by a professional who adds value to the operation, such as an engineer, who has a range of skills that doctors, nurses, and assistants do not have," says the doctor. "We are moving from a traditional model to a completely personalized one."

Democratization in surgery:

The machines, which are semi-professional, are making copies throughout the day if necessary. Depending on the degree of complexity, such as a fractured pelvis, the process can take more than two days. If the piece is simple, it takes no more than a few minutes.

The long hours in the operating room and the situations surgeons face sometimes spark ideas in their minds about products that would be useful but do not exist on the market. Now they are achievable, whereas before they were nothing more than a mere sketch on paper after the operation: "We often come up with solutions that were difficult to implement, but with this technology it's as easy as going up to the fifth floor, where they are translated and take shape with the engineers."

In fact, they already hold a few patents. But the most rewarding thing in this regard is that there are many colleagues around the world who, once they have a lightbulb moment, if they see that it could be helpful in other hospitals, upload it to the internet and doctors simply have to download the file and proceed to print it in the laboratories with the engineers.

A promising future:

Pablo Andrés Cano believes that in the not-too-distant future, the healthcare system itself will be able to manufacture prostheses, which, among other things, would reduce waiting times and significantly lower costs: "The trend is towards having factories or manufacturing centers for healthcare products that are available to the system."

"It may not be profitable for every hospital to have a factory to make them, but perhaps the Andalusian Health System, which is the largest healthcare company in Spain, could have a center dedicated to this and distribute them from there," he explains.

One of the functions of the Hospital Surgical Planning and 3D Printing Commission is to advise on the economic importance of these initiatives, as they could optimize other processes. The orthopedic surgeon gives an example: "Producing a surgical guide avoids going to the industry, and perhaps for two euros you can do something that a company charges 300 for, a negligible cost in comparison."

Continuing education:

As this technology is constantly evolving, professionals need to continuously learn from training that often quickly becomes obsolete because advances are happening faster than learning itself.

"This requires staying up to date because technology is constantly changing. It's a revolution, just like CT scans and MRIs were in their day. The good thing is that when 25 years have passed, we'll have the satisfaction of knowing that we contributed to it from a laboratory in Cádiz, Cádizsays the doctor.

He takes the opportunity to thank two veteran colleagues, Pedro Cano and José Antonio Andrés, former heads of service at Virgen del Rocío and Puerta del Mar, respectively: "They have seen it all, they have a wealth of experience, and yet from the outset they supported this technology, which has been very important in making this laboratory a reality."

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