A robotic platform for navigated intraoperative 3D printing of patient-specific implants

Abstract A common approach to implant fabrication relies on the preoperative fabrication of implants made of biomaterials such as polyetheretherketone (PEEK) or ceramics. This method provides limited applicability for emergency interventions or in surgeries where tissue preparation deviates from surgical planning. To address this limitation, intraoperative 3D printing has been presented as a novel approach to fabricating implants directly onto native tissue, allowing a highly flexible implant design and fabrication. However, most of the platforms presented for intraoperative 3D printing lacked a focus on direct clinical translation. Here, we realized and evaluated an intraoperative 3D printing platform that combines a market-available robotic manipulator and a surgical navigation system, both medically certifiable. We evaluated the world registration accuracy of the platform, obtaining an average path deviation of 0.4 mm when printing. We also demonstrated the capacity to fabricate a multilayer, nonplanar porous structure on surfaces with local normal variations within ±10° and nozzle diameters down to 0.8 mm. We conclude that nozzle direction adjustments during printing and a higher-precision robot would be required to fully exploit the possibilities of intraoperative 3D printing.