World first for NHS airway collaboration

19 June 2023

The Airway Innovation Group, a collaboration between Northern Care Alliance NHS Foundation Trust anaesthetists, ENT surgeons and clinical engineers has achieved a world first by using a 3d printed patient-specific intubation guide to help complete a complex surgical procedure. 

The Group which is dedicated to developing new techniques and devices to improve care for patients with complex and difficult airways was contacted by the Liverpool Heart and Chest Hospital about a patient with a rare condition called mucopolysaccharidosis (MPS). 

The disease affects various parts of the body, some of the life-threatening ones being related to the heart and airway. The patient had a very complex and difficult airway, due to a limited mouth opening, large tongue, and bent trachea (windpipe). The patient needed essential surgery on their heart but due to their airway condition, this was proving to be a challenge for surgeons. 

Mr Chai Gadepalli, consultant ENT surgeon and member of the Airway Innovation Group at Salford Care Organisation, describing the issue faced by surgical teams, said: “A difficult airway is where the patient has complications which make it difficult to provide oxygen during operations. If the anaesthetic team cannot provide oxygen, either through a mask or through a tube inserted into the airway (intubation), then the operation cannot proceed.” 

After two failed attempts at surgery in another hospital the patient could not be intubated and as a result could not safely undergo surgery with an anaesthetic. Their heart disease had progressed since then, and a solution to help the patient to be safely intubated and anaesthetised to allow for their essential surgery was now urgently needed.

As part of the 3dSPIN (3d Surgical Planning and Innovation) project, the Airway Innovation Group had recently developed a set of new methods and instruments designed specifically for complex airways, and by applying these together for the first time would allow the surgical team to safely go ahead with the surgery for this patient. 

First a 3d printed model was constructed which reproduced the patient’s airway. The model was manufactured using flexible silicone rubber and foam materials, which provided more realistic experience for the surgical team when practicing intubations. The CT scan images were also turned into virtual reality simulations, allowing the surgical team to view the internal structure of the patient’s airway in detail, helping them to visualise the pathway of the patient’s windpipe, and develop a method to overcome these obstacles and safely intubate. 
Numerous rehearsals of the intubation technique were carried out by the Salford and Liverpool team on the computer model, the physical simulation model, and using the virtual reality headset. With the procedure thoroughly simulated and practised, the airway plan was executed successfully on the day. The patient was successfully intubated and was able to have their the surgery carried out safely.
Dr Stuart Watson, who leads the clinical engineering team at the Northern Care Alliance, said: “The 3dSPIN project is aimed at encouraging and enabling our clinicians and engineers to collaborate in the adoption and translation of bringing 3d printing and virtual reality into routine use within our hospitals and the wider NHS. It’s really exciting to see these new developments now being used by our surgical teams to provide better outcomes for patients.”

Mr Chai Gadepalli (far left) and the Clinical Engineering R&D team .png 3d printing model.jpg 3d printing model 2.jpg Computer model.png

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