Medical Firsts Sample
The first use of a 3D printed hand prothesis occurred in late November 2012. It was developed through a collaboration between two people 10,000 miles apart that would never have met without the internet. The hand project started when Ivan Owen, a special effects prop maker in Bellingham, Washington, made a 3D printed claw-like hand for cosplay and posted a video of it on YouTube.
Richard Van As, a South African carpenter who had lost fingers in a table saw accident, happened to see the video. He had been searching for a prosthetic finger but discovered that because it had to be custom made, it cost thousands of dollars more than he could afford. After he saw Owen’s video, he tried unsuccessfully to make a similar device for himself. When he failed, he e-mailed Owen for help.
A mother in South Africa saw a Facebook post about Van As’s prosthetic finger and got in touch with him. Her five-year-old-son, Liam Dippenaar, had been born without fingers on his right hand as a result of a condition called amniotic band syndrome (ABS). In ABS, the amniotic sack that surrounds the developing fetus is damaged, and the fetus becomes entangled with it in a way that can restrict blood flow to some part of the body. In Liam’s case, limited blood flow kept the cells in his right hand from developing into fingers. Liam’s mother asked if a hand could be made for her son. Van As and Owen rose to the challenge. The company MakerBot donated two 3D printers, and using them, the men were able to make a customized prosthetic hand for Liam for about $150. They called their creation Robohand and chose not patent the process.
Robohand contained wrist hinges, knuckle plates, and other parts that were 3D printed. The parts were connected with cables and stainless steel bolts. With Robohand, Liam could pick things up and throw a ball. Best of all, when he outgrew the hand, he could get a new, appropriately sized prothesis at an affordable price.
In January 2013, the files to print Robohand parts were made freely available worldwide, and soon 3D printing hobbyists were volunteering to make hands for those who needed them. This led Ivan’s wife, Jen Owen and Jon Schull, and Jeremy Simon to found e-NABLE, a not-for-profit organization that connects people needing hands with volunteers interested in making them. Today there are e-NABLE volunteers on every continent except Antarctica, and customized prosthetic hands can be made with volunteer labor and between $15 and $50 in materials. This has changed the lives of thousands of children whose parents could not afford new, customized prosthetics that are needed as often as every six to nine months as a child grows.
Historical Context and Impact
Protheses have been used since ancient times. One of the earliest was a wooden toe found on a 3000 year old Egyptian mummy. The earliest known hand prosthesis was made of iron. It was described by Pliny the Elder Pliny (c. 23–79 CE) almost three centuries after its owner had died. Pliny claimed that it was made for Roman general Marcus Sergius who lost his right hand in battle during the Second Punic War (218–201 BCE)
Most early prosthetic hands were made of metal, and most were for soldiers. In the early 1500s, Bavarian knight Götz von Berlichingen (1480–1562), also called “Götz of the Iron Hand,” had an iron prosthetic hand made after he lost his own in battle. The prothesis was so heavy that it had to be attached to his armor for support, but it allowed him to hold the reins and control his horse in battle.
World War I (1914–1919) and World War II (1939–1945) accelerated the need for prosthetic limbs. By the 1950s, cables had mostly been replaced by rechargeable batteries to move the fingers in hand protheses. These were still awkward, often uncomfortable devices, but the development of transistors and plastics soon made them lighter and more flexible.
Prosthetic hands continued to improve as new materials such as titanium were introduced, but the prostheses were still limited in their ability to do delicate tasks. Because they had to be custom built with meticulous craftsmanship, prosthetic hands could cost as much as $10,000. This put them out of the reach of many people.
The improvement of prosthetic hands has continued. In 2016, researchers created an entire hand made completely from soft, flexible materials including the electronic circuitry used to operate the hand. This advance allowed users to perform more delicate and precise tasks. In 2021, a team at the University of Maryland announced that they had produced a 3D printed hand that was flexible enough, fast enough, and had enough tactile feedback to beat level one of the Nintendo video game Super Mario Bros.
The groundwork for 3D printing that made these advances possible was established by Hideo Kodama of Japan. In 1981, he developed the idea of using ultraviolet light to polymerize thin layers of a photosensitive resin. Although he built a machine that he called a “rapid prototyping device.” he lacked funding and failed to file a patent in a timely way. In 1986, a French team patented a device similar to the one that became the first 3D printer, but their inability to explain commercial uses for the machine led to a lack of funding and the project was dropped.
American Charles Hull (1939–) is considered the father of 3D printing. He developed a technique called stereolithography (SLA) as a faster, cheaper way to make prototypes. Hull patented his first SLA machine in 1986. The device used ultraviolet light to bond thin layers of plastic to make 3D objects. Early machines cost $300,000 ($812,000 in 2022). Hull expected the machines to be used in industry. He had no idea that his invention would change the world of medicine. The first medical use of 3D printing occurred in the late 1990s when the technique was used to make custom dental implants. For his invention of SLA printing, Hull was inducted into the National Inventors Hall of Fame in 2014.
Since the development of SLA, other 3D printing techniques have been devised. Carl Deckard (1961–2019) developed a technique called selective laser sintering (SLS) and S. Scott Crump invented fusion deposition modelling (FDM). These different processes work on somewhat similar principles as SLA. A liquid, gel, or very fine particles are extruded by a nozzle. As the nozzle moves rapidly across a surface, it ejects thin layer of particles. A special type of light makes the particles bond and harden. The placement of the particles by the nozzle is determined by a computer program. Eventually a solid three-dimensional object is created. The process can take anywhere from a few hours to a few days depending on the size of the object and the capabilities of the printer.
3D printers have experienced an ever expanding range of uses because of the evolution of faster, more powerful, and less costly computers and advanced computer aided design (CAD) software. These developments extended the industrial use of 3D printing and also reduced the cost of the technology to make it within reach of many hobbyists. This has allowed organizations such as e-NABLE to harness the skills and goodwill of people across the globe to make inexpensive prostheses as well as changing to prosthesis industry.
More medical advances are expected to come from 3D printing. In March 2022, 3DBio Therapeutics, a regenerative medicine company, announced that it had produced an ear for a woman who was born with one normal and one very small ear. The company scanned the normal ear, took cartilage cells from it, grew them in a gel, and then used 3D printing methods to create an identical ear out of the gel that contained the woman’s cartilage cells.
The new ear was surgically implanted, and the cells were expected to continue to grow and produce cartilage. The procedure was cosmetic; it did not change the woman’s hearing. At the time this book was written, the new ear had not been in place long enough to know if the process was a long-term success. If it is, this opens up a whole new area of regenerative medicine.