3D printing of surgical hernia meshes impregnated with contrast agents: in vitro proof of concept with imaging characteristics on computed tomography

Abstract

BackgroundSelected medical implants and other 3D printed constructs could potentially benefit from the ability to incorporate contrast agents into their structure. The purpose of the present study is to create 3D printed surgical meshes impregnated with iodinated, gadolinium, and barium contrast agents and characterize their computed tomography (CT) imaging characteristics. Commercial fused deposition layering 3D printing was used to construct surgical meshes impregnated with imaging contrast agents in an in vitro model. Polycaprolactone (PCL) meshes were printed containing iodinated, gadolinium, or barium contrast; control PCL meshes without contrast were also fabricated. The three different contrast agents were mixed with PCL powder and directly loaded into the 3D printer. CT images of the three contrast-containing meshes and the control meshes were acquired and analyzed using small elliptical regions of interest to record the Hounsfield units (HU) of each mesh. Subsequently, to test their solubility and sustainability, the contrast-containing meshes were placed in a 37 °C agar solution for 7 days and imaged by CT at days 1, 3 and 7.ResultsAll 3D printed meshes were visible on CT. Iodinated contrast meshes had the highest attenuation (2528 mean HU), significantly higher than both and gadolinium (1178 mean HU) and barium (592 mean HU) containing meshes. Only barium meshes sustained their visibility in the agar solution; the iodine and gadolinium meshes were poorly perceptible and had significantly lower mean HU compared to their pre-agar solution imaging, with iodine and gadolinium present in the adjacent agar at day 7 CT.Conclusion3D prints embedded with contrast materials through this method displayed excellent visibility on CT; however, only barium mesh maintained visibility after 7 days incubation on agar at human body temperature. This method of 3D printing with barium may have potential applications in a variety of highly personalized and CT visible medical devices.

3D Printing Custom Bioactive and Absorbable Surgical Screws, Pins, and Bone Plates for Localized Drug Delivery

“…The present study showed feasibility of 3D printing screws, plating, and other constructs impregnated with drugs, and profiled the mechanical properties effect of incorporating these drugs into the 3D printed constructs. The drug impregnating capabilities are similar to prior in vitro studies that incorporated antibiotics and chemotherapeutics into 3D printed constructs [8,9,11,15,16,17]. Several studies have shown antibiotics and chemotherapeutics incorporated into 3D printed filaments, catheters, and meshes [9,11,15].…”

3D Printing of Drug-Loaded Thermoplastic Polyurethane Meshes: A Potential Material for Soft Tissue Reinforcement in Vaginal Surgery

“…Some preliminary work has been done about the use of 3D printing for mesh implant manufacture. However, these works were not realistic as they propose the use of materials such as PLA or PCL that are biodegradable and do not present appropriate mechanical properties for this task [38,48,49]. Some of these works incorporated some antibiotics to the material.…”

3D Printing for Bio-Synthetic Biliary Stents

“…These stents were successfully modified with barium contrast to create x-ray attenuation, an important factor for fluoroscopic visualization and localization during endoscopic procedures. A prior study of impregnated contrast materials showed barium to be more resilient than iodinated contrast materials when incorporated into the structure of 3D-printed constructs (i.e., surgical mesh used in that study) [22]. Additional PCL and other polymer coatings or drugs could be applied to PVA-based stents for a variety of material modifications including increased mechanical properties, enhanced cell attachment, and optimal drug delivery.…”

“…Cytocompatible, hydrophilic, and drug-deliverable 3D printed materials and techniques have been recently explored and hold great promise in cell culture models, medical devices, and tissue-engineered substrates [22,23,24,25]. Such materials include 3D printed polyvinyl alcohol (PVA), a water soluble polymer.…”