Although three-dimensional printing technology is an emerging solution for a number of real world problems, there has not been much research into the viability of 3D printing of surgical instruments. However, my colleagues and I recently conducted a study in the Journal of Surgical Research showing that 3D printers can produce durable, sterile surgical instruments at a cost of about 10 percent of the price of stainless steel OR tools.1
Using a fused deposition printer, we replicated an Army/Navy surgical retractor from a polylactic acid filament, a process that took about 90 minutes. We sterilized the retractor using standard Food and Drug Administration approved glutaraldehyde protocols and tested the retractor for bacteria by polymerase chain reaction. As far as a learning curve, we think there is a great deal of learning required not only to 3D print but also for 3D printing manufacturers.
The instruments we printed out were durable enough to withstand a great deal of stress and would likely be able to withstand the average surgery with repeat sterilizations in the field. Specifically, the instrument tolerated 13.6 kg of tangential force before failing, both before and after exposure to the sterilant. The freshly extruded polylactic acid from the printer was sterile and we found it produced no polymerase chain reaction product. Each instrument weighed 16 g and required only $0.46 of polylactic acid.
This is really an amazing time. It is not unlike what we saw in the 1990s with the rise of digital media when someone could rip a CD and have a near duplicate as an MP3. That gave rise initially to things like Napster, which then gave rise to things like Spotify and iTunes. Now we are starting to see something similar but not for audio files or for video, but for actual physical things. Imagine being able to print out a knob that broke on your radio dial or a door handle. That is what we are starting to see now. Imagine, though, printing out composites like tissue. This is already happening—and will one day be ready for prime time.
Three-dimensional printing is almost like the Napster of things. It is a tremendously exciting time in this area and we at the Southern Arizona Limb Salvage Alliance (SALSA) are excited to be a part of it.
1. Rankin TM, Giovinco NA, Cucher DJ, Watts G, Hurwitz B, Armstrong DG. Three-dimensional printing surgical instruments: are we there yet? J Surg Res. 2014; epub Feb. 19. Available at http://www.sciencedirect.com/science/article/pii/S0022480414001644  .