Since its creation in 2016, the 3D Printing Program at UPMC has helped surgeons plan complex and challenging procedures.
In 2024, it helped 4-year-old Victor Kleinberger breathe easier.
Victor needed a delicate surgery to remove a cyst that was pressing on his left airway, impairing his ability to breathe. His surgeon, Stefan Scholz, MD, enlisted the 3D Printing Program to create a model of the cyst’s location inside Victor’s chest.
The 3D model helped Dr. Scholz plan the surgery to safely remove the cyst with very small incisions and help Victor breathe better. The process required collaboration between Victor’s family, the surgical team, and the 3D Printing Program.
A Troubling Condition
Victor struggled with respiratory illnesses for much of his young life. Even a common cold could linger for three weeks or longer.
“You always hear when people go into daycare that it’s just one illness after another,” says Laura Gomez-Martin, Victor’s mother. “And that’s kind of the way it was with Victor, except his illnesses just really seemed to last a lot longer. It’s not that he would get sick more often, but when he got sick, he had a lot of trouble kicking it.”
When he got sick, Victor had a deep, congested, mucus-filled cough. Because of his condition, Victor had trouble sleeping, eating, and keeping up with his older brother and other children when playing.
“When he would run around with other kids, he needed to take more breaks than other kids,” Laura says. “He’d kind of tap himself out of the game. They were playing, and he’d go sit down and just rest a little bit before continuing to play.”
Despite frequent visits to Victor’s pediatrician, a trip to the emergency department, and strong antibiotics, Victor’s condition remained.
In February 2024, Victor had a respiratory illness that was particularly severe, so his parents brought him to the emergency department. A chest x-ray showed signs that Victor’s left lung was hyperinflated, so he was referred to the Division of Pulmonary Medicine at UPMC Children’s Hospital of Pittsburgh.
The pulmonary specialists ordered a computed tomography (CT) scan of his chest. The scan took place in early June and revealed a bronchogenic cyst in Victor’s chest.
A Delicate Procedure
Bronchogenic cysts are rare, fluid-filled, congenital growths in the chest abutting the respiratory tract. Victor’s cyst was 4.2 centimeters wide — about the size of a large walnut. It was located below the carina, the first division of the main airway in the center of the chest. The cystic mass was compressing his left main bronchus, the airway that goes from the trachea to the lung.
“It made sense because even when he was a baby, he was always kind of a hard breather,” says Jeff Kleinberger, MD, Victor’s father and a former pathology resident and fellow at UPMC. “He would be breathing with his shoulders a lot.
“When we saw the CT scan results, it made us realize that he’d been really fighting an uphill battle, working against this thing pushing against his airway.”
Victor needed surgery to remove the cyst to avoid future complications like infection. He was referred to Dr. Scholz, who specializes in minimally invasive pediatric procedures.
The surgery would be difficult because of the size of the cyst and its location. Not only was the cyst pushing against Victor’s airway from underneath, but it was also next to the esophagus, the heart, and critical blood vessels in the center of the chest.
Another challenge was that the surgery had to be completed soon due to life circumstances. Jeff was finishing his pathology fellowship at UPMC, and the family was scheduled to move in July to be near his new job. In addition, Laura was seven months pregnant.
“It was just a lot of things happening at the same time,” Laura says.
A Collaborative Process
Dr. Scholz had worked with the 3D Printing Program to develop 3D models before, so he enlisted their help again.
“In this particular patient, because of the very complicated or complex location of this, I thought it was very helpful to make this 3D model,” Dr. Scholz says.
UPMC’s 3D Printing Program works with surgeons to develop models to plan difficult procedures.
“Because we have a specialized team where this is what we do, we have developed expertise in being able to make these complicated models and identify these complex anatomies in a way that you can’t do without a team that is focused on this all day, every day,” says Anish Ghodadra, MD, interventional radiologist and founder and medical director of the 3D Printing Program.
A surgeon contacts the program to describe what they need. The program’s engineers take patient imaging like CT scans and use software to create a virtual 3D model. The surgeon then reviews the 3D model and can recommend changes so the model fits their need.
“Because cases are so complicated and very niche, we want to make sure that what we’re producing is useful for them,” says Elliott Hammersley, lead biomedical engineer of the 3D printing team. “We’ll sit down, and I’ll show them what I’m thinking, and if it’s not exactly what they want, we’ll adjust to make it fit their needs as much as possible.”
After the virtual 3D model is finalized, a board-certified radiologist reviews it to ensure its accuracy. Once approved, it is printed into a physical 3D model.
In Victor’s case, it took a day for Elliott to create the final virtual model and a day to print the physical 3D model.
“The more responsive the surgeon or physician that we’re working with is, the better,” Elliott says. “Dr. Scholz is great because he makes an effort to understand the technology and what we’re capable of and then makes his requests with the solution in mind. He can give me an accurate idea of what is possible and what he actually wants.”
Putting a Plan in Place
After receiving the 3D model, Dr. Scholz used it to plan Victor’s surgery, consulting with other members of the surgical team.
Dr. Scholz’s planned surgical approach posed a challenge for the anesthesia process. To be able to perform the surgery minimally invasively, only the left lung, past the airway blockage, had to be intubated. The model helped him and the anesthesiologist to discuss and develop an optimal plan for safe anesthesia.
The location of the cyst also posed challenges, so Dr. Scholz used the model to understand the only possible access window to this large lesion: a small area between the right lung, esophagus, and major vessels going and coming from the heart.
“There are lots of complexities with this surgery, so this model was really helpful for planning this with the anesthesia as well as the surgical team, and visualizing also for myself,” Dr. Scholz says. “We as surgeons look all the time at CT scans, and we’re pretty good at doing 3D reconstructions in our head, looking at different perspectives, and then translating that into how you would do the surgery.”
“But this model takes it to a whole different level. You can explain not only to the parents but also the whole surgical team what we plan to do and what is the best way of doing this, as well as a plan B as backup. And then, with some surgical experience, you can make the best plan in order to attack this.”
Dr. Scholz also used the model to explain the surgery to Laura and Jeff.
“The 3D model was really helpful in that when you’re looking at a CT scan, you’re kind of looking at sections up and down,” Jeff says. “But the 3D model allowed you to look at it from a sideways perspective. You could hold it in your hands, and turn it this way, and see the path that he wanted to take to get to it.”
A Successful Surgery
Victor’s surgery took place on June 18, shortly after he turned 4 years old. Dr. Scholz used three small 3-millimeter incisions in his right chest to access and remove the cyst. Jeff and Laura noticed a difference in Victor soon after the surgery.
“I can’t believe he recovered so quickly,” Jeff says. “We have a video of him hours after the surgery in the playroom at the hospital, and he’s dunking a basketball.”
Victor’s appetite and sleep have also improved, and the first time he got a cold, it went away quickly.
The family has moved, and Victor has a lot more room to run around with his older brother and his friends. His baby sister was born soon after the move, and Laura says Victor is “totally in love.”
Laura and Jeff are thankful for the care Victor received.
“I’m just so thankful for Dr. Scholz’s ability to be accommodating to our life at the time,” Laura says. “He was so helpful, forthright, and clear with us about what was going on and the expectations.”
Success stories like Victor’s are an example of the 3D Printing Program’s value, Dr. Ghodadra says.
“Because our program is located in the hospital, we can work quickly and efficiently,” he says. “This was a complex case and required a lot of close communication between Elliott, the cardiac imagers, and the surgeon to make sure we’re making a model that not only is technically accurate but designed in a way that helps plan the surgery and helps solve any potential problems that might arise.”
“It’s not simply just hitting ‘File, Print’ on the anatomy but making something that conveys the most useful information in a clear way. And that can only really happen at the point of care.”