Craniosynostosis must often be corrected using surgery, by which the affected bone tissue is remodeled. Nowadays, surgical reconstruction relies mostly on the subjective judgement of the surgeon to best restore normal skull shape, since remodeled bone is manually placed and fixed. Slight variations can compromise the cosmetic outcome. The objective of this study was to describe and evaluate a novel workflow for patient-specific correction of craniosynostosis based on intraoperative navigation and 3D printing. The workflow was followed in five patients with craniosynostosis. Virtual surgical planning was performed, and patient-specific cutting guides and templates were designed and manufactured. These guides and templates were used to control osteotomies and bone remodeling. An intraoperative navigation system based on optical tracking made it possible to follow preoperative virtual planning in the operating room through real-time positioning and 3D visualization. Navigation accuracy was estimated using intraoperative surface scanning as the gold-standard. An average error of 0.62 mm and 0.64 mm was obtained in the remodeled frontal region and supraorbital bar, respectively. Intraoperative navigation is an accurate and reproducible technique for correction of craniosynostosis that enables optimal translation of the preoperative plan to the operating room.

Me gustaría agradecer a mi tutor, Javi, por confiar en mí y darme la oportunidad de crecer como ingeniero, como investigador, y como persona. Muchas gracias por estar siempre ahí dispuesto a ayudar, por tu empatía, por tu conocimiento, y por tu forma de ser. Ha sido un placer tenerte como tutor durante todos estos años.También agradecer a mis compañeros inseparables. A Moni, por aparecer en mi vida y ser la mejor compañera de viaje. Por su mirada, su sonrisa, su empatía, por ponerle música y color a mi vida, y por mucho más. A Rafa, por su energía, su humor, su honestidad, su generosidad, su capacidad de escuchar, sus tonterías en los momentos buenos, sus ánimos en los momentos difíciles, sus críticas constructivas, y su personalidad. Ha sido un placer trabajar junto a vosotros estos últimos 4 años, y sois claramente los culpables de haber hecho del doctorado la mejor etapa de mi vida. Sin vosotros todo esto habría sido muy distinto. Gracias por nuestros experimentos, nuestras cirugías, nuestros inventos, nuestros viajes (

Background The integration of 3D printing technology in hospitals is evolving toward production models such as point-of-care manufacturing. This study aims to present the results of the integration of 3D printing technology in a manufacturing university hospital. Methods Observational, descriptive, retrospective, and monocentric study of 907 instances of 3D printing from November 2015 to March 2020. Variables such as product type, utility, time, or manufacturing materials were analyzed. Results Orthopedic Surgery and Traumatology, Oral and Maxillofacial Surgery, and Gynecology and Obstetrics are the medical specialties that have manufactured the largest number of processes. Working and printing time, as well as the amount of printing material, is different for different types of products and input data. The most common printing material was polylactic acid, although biocompatible resin was introduced to produce surgical guides. In addition, the hospital has worked on the co-design of custom-made implants with manufacturing companies and has also participated in tissue bio-printing projects. Conclusions The integration of 3D printing in a university hospital allows identifying the conceptual evolution to “point-of-care manufacturing.”

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