Nakul (Name changed) is a young software engineer working in Bangalore. He was literally carrying a huge burden on his shoulders when he first presented to us. With a massive tumour on his left shoulder, which had progressed to the size of a basketball, his daily activities were grossly restricted and caused him excruciating pain throughout the day. He had visited many doctors across the country who had all advised amputation of the limb, for which he was clearly not ready. He saw himself achieving much more with his professional life, which had just started and strongly felt the need in retaining his limb. We concurred with him on this and set out our journey to plan and save his limb using all possible means in the medical world.
To remove the chondroid tumour in his left humerus (arm bone) that had extensively extended into the neck, back and chest wall was in itself a major challenge. Upon that, reconstructing his shoulder to achieve a functional limb in the future was an additional task. Once the massive shoulder tumour is removed, he would be left with a significant bony defect that has to be reconstructed so that the limb can be used efficiently. Regular commercially available implants or prosthesis are designed only to replace a joint or a part of the bone and sometimes the entire bone. But in Nakul’s case, 3 crucial bones needed to be reconstructed or replaced.
With around 5years of experience in 3D printing technology for oncological surgeries, we explored the option of 3D printing the required bones. After 5 long months of scans, discussions, designing, prototyping and brainstorming, we could 3D print the titanium implants as desired. This involved a lot of coordination and communication with the engineers in Mumbai, where the implant was brought to life. It was vital for them to thoroughly understand our requirements and finer surgical aspects. We also sought help from our mentor Dr Marco Manfrini in Italy, and suggestions from the experts in using 3D printed orthopaedic implant from the world over.
Considering the size and extent of the tumour, we planned the surgical procedure over two consecutive days. The first day was dedicated to removing the tumour by saving the crucial structures like nerves and vessels needed for normal hand function. The second day was for the reconstruction. Since both aspects of the surgery required utmost commitment, concentration and precision, it was performed over two days. A team of about 10 dedicated doctors from different fields were involved in the surgery. Multiple trials with the implants, a preplanned surgical scheme, a comprehensive armamentarium of devices, and clinical expertise in the operating room helped us perform the surgery without hiccups. The initial recovery was equally smooth, and the patient went home walking within a week.
It was not easy for us to undertake this complex surgery; removing the hand was an easier option. But the effort each one of us has put, including the patient and his family members, is totally worth it after seeing him today. Our mission of delivering the best outcome in the world by involving the best professionals and adopting cutting edge technology drove us in making this surgery possible. Accomplishing such procedures can eventually become an everyday practice if we all can take that extra step. Patients, medical professionals, allied support staff, engineers, government organizations, and everyone else linked to the betterment of healthcare in our country can and should contribute up to their full potential.
Though Nakul and his family have won the battle, they have a long way to go in terms of follow-up and rehabilitation to get back to work and everyday life. And so do we, to reach our vision to become the world leader in managing bone and soft tissue tumours & deliver the best outcome for every sector of society.