Dr. Jon Zabaleta obtained his MD and PhD in Medicine from the University of the Basque Contry (UPV / EHU), Thoracic Surgeon at Universitary Hospital Donostia and Associate Professor of Biomedical Engineering at Tecnun-School of Engineers (University of Navarra). Impulse and coordinator of the Multicenter workgroup of the Spanish Society of Thoracic Surgery (SECT) for the “use of 3D models to Improve preoperative surgical planning study and thoracic pathology in Patients With.”
Dr. Zabaleta was a speaker at 3DHEALS VIGO EVENT 2017. 
 
 

Jenny: What inspired you to use 3D printing in your work?

Jon: First of all, I was so lucky to discover the work in maxillofacial surgery that 3D printing was doing from my colleague Pedro Martinez Seijas. Some months after, we were planning a broncho-plastic procedure to preserve as much as possible of lung parenchyma in a lung cancer patient. It’s a very stressful procedure and many times we are not sure if we will be able to suture both sides of the resection. With this case, we started thinking about 3D printing to improve the preoperative study in general thoracic surgery.

Jenny: Wha is the biggest motivation for your work?

A: Our patients. They are expecting us to give the best we can, and my promise to the patients it’s the most important. We are a team of four thoracic surgeons in San Sebastian, and we are all trying to keep up-to-date in the latest techniques, studying and always trying to do our best for our patients.

Jenny: What is the biggest challenge in your work?

Jon: Without any doubt the Thoracic oncology. In this moment, lung cancer is the highest cancer-related cause in Europe and the USA, and we are still operating on only 20% of them. We have good results after surgery, but we need to improve the percentage of patients coming to the OR.

Jenny: How do you approach working with people with different backgrounds?

Jon: It’s very important to be open minded, and never judge. Everyone can be great in his area and know nothing in a new field. The most important thing is to create an environment without fears about saying anything. And with all the ideas, start creating something new, or with already existing technology, giving them a new use. It’s very important to forget the old days when the boss/chief was supposed to know everything, these days the knowledge is so wide, that nobody can know everything in every area. For real teamwork what we need is humility.

Jenny: How do you plan to conquer this challenge?

Jon: Teamwork is the key. This is our best bet. We want to work together with engineers, radiologist, and surgeons. Because when we are working together, we are improving the study quality of the case we are working with, but in addition to that, we are learning a lot of things about general radiology or general engineer science and culture. Because I realize that engineers and medicine doctors we have similar ways of working, and many times similar personalities. But we live parallel lives, and when we start mixing them, anything can happen.

Jenny: What is your vision on the potential impact of your current work to the future of medicine?

Jon: We think that after our work with 3D printing for preoperative study, it will become part of the routine for some cases. Our main goal is to determine in which cases we can perform 3D models, in which cases a virtual model can be enough, and in which cases a 3D printed model is helpful and necessary. We think that the next step will be around airway stenosis, trying to print personalized stents for airways.

3DHEALS GALICIA 2017

Jenny: What is the biggest change/improvement since last year this time?

Jon: The field of general thoracic surgery is under explored because of two big difficulties: 1) we have a lot of soft-tissue (that incurs difficulties for segmentation) and 2) we have few cases per hospital annually, which makes the learning curve difficult. The biggest change or achievement for the use of 3D printing, is the creation of a multicenter study in Spain, with 26 hospitals joining the project, and every professional showing different problems with the same goal: give the patients the best solution using already existing technology.

Jenny: What are you passionate about?

Jon: About my family. I have a 4-year-old and a 2-year-old son and I love to play with them in the afternoon and weekends. I love planning holidays with my wife and whole family because, with our work, one thing I have learned is that today we are here, but what about tomorrow? I never say no to a plan that I like. Live life fully.

Jenny: What do you enjoy in your spare time?

Jon: To stay with my family and sports: soccer, speed skating, running… and one thing that my wife and I discovered 3 or 4 years ago: escape rooms. We have a lot of fun with them and when we are going to different cities for the weekend, we always try to go to a escape room.

Jenny: What else do you want to share with us?

Jon: We find a very interesting thing with 3D printing, which on many occasions people don’t speak about because you can’t measure it and it’s not a monetary thing. When you show a 3D model to a patient, a special link between the patient and doctor is made. This model makes the patient feel special, he knows that he is not the patient of Monday or patient in room 220, he knows that for the surgeon this is a special case and we are offering him a special solution specifically built for him. And to feel this with patients, it’s something marvelous.

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Dr.  Pedro Martínez Seijas is a board certified Oral and Maxillofacial Surgeon in Vigo, Spain. He also holds Master degree in Biomedical Engineering and medical direction and clinical management. Since 2003, Pedro has been working in Clinical Innovation applied to 3D printing and surgical simulation in oncological-maxillofacial reconstructive surgery and maxillofacial-skull deformities.
“The Pedro I met during our 3DHEALS Vigo event is more than titles and degrees. To me, Pedro is truly legendary in the field of healthcare 3D printing. He has been using 3D printing in his practice for 15+ years, changing many’s lives in Spain. Pedro in person is down to earth, friendly, and kind. This enabled him to be an extremely effective leader in the Spanish 3D printing community and an excellent co-organizer of the event.” – Jenny Chen, M.D.
 

Jenny: What inspired you to use 3D printing for your work?

Pedro: There are patient’s problems that we haven’t the best solution, only standard solutions. Under this condition, I started my search for personalized solutions in 2001. When Dr. Arruti and I discovered that 3D CT scan reconstruction could give us a new complementary vision of the patient’s condition and we asked ourselves: “Can we use 3D CT scan data in a physical form for surgery simulation? Then we began searching for engineers for this purpose and it was a difficult enterprise because in Spain there isn´t a specialization for healthcare.

In 2001, the bio-models price was very high, but we started working with it anyway. For our patients, that was science fiction. In our surgeries, it became a routine since 2007.

3D Printing Journey: 2001 “Patient 0” in 3D printing

3D Printing Journey: 2001 “Patient 0” in 3D printing

As time goes, the price of these bio-models became lower and it started to democratize and wide-spread it uses. Now we are in a new era for 3D printing in healthcare.

Jenny: What is the biggest motivation for your work?

Pedro: The patients and limits for their treatment was my principal motivation. I worked hard to improve this technology so that we could give our patients effective treatments that standard techniques could not.  These are working for patients based on the patients’ testimonies. My parents and education guided my life and my work. I try to improve the “magic” in my clinical practice, investigation, and teaching. There is no limit to achieving excellence.

Jenny: What is the biggest challenge in your work?

Pedro: The biggest challenge in my work is when the surgeries went wrong and there are complications. It is my obsession to find solutions and reduce/avoid complications. Clinical safety for patients is the biggest priority for me. PPPM or prediction, prevention, and personalization medicine is my mantra. 3D printing is a great tool and they are improving surgeon’s experience, resources, knowledge, and skills. 3D printing can provide surgical quality control, variability control, and can improve clinical safety.

3D Printing Journey: 2007. Pedro’s team routinely used 3D printing for head and neck reconstruction.

3D Printing Journey: 2007. Pedro’s team routinely used 3D printing for head and neck reconstruction.

Jenny: How do you approach working with people with different backgrounds?

Pedro: Based on my clinical knowledge and past clinical experiences, I believe in multidisciplinary work and I think that networking is one of the best ways to improve solutions for patients.

Jenny: How do you plan to conquer this challenge of having to work with people with different backgrounds?

Pedro: I play several different roles: oral and maxillofacial surgeon, biomedical engineer, and also a medical director. Because of this, I can speak to engineers in engineering language, speak to doctors in medical language,  and speak to medical directors in administrator’s language.

3D Printing Journey: 2009, Two hemi-mandible custom-made prostheses.

Jenny: What is your vision on the potential impact of your current work to the future of medicine?

Pedro: I think that 3D printing will be used routinely around the world very soon. My impact is very small: “like an insect impact with a car”. I try to improve the technological advances based on clinical process management, efficiency, safety, and quality control in oral and maxillofacial surgery. I think that regenerative medicine, bioprinting, big data orientated for improving personalized medicine will be with us soon. By the way, networking and multidisciplinary work using clinical process management can help with the challenges in ordering and controlling clinical variability.

3D Printing Journey: 2011, New mid facial osteotomy 3D printing and navigation surgery.

Jenny: What is the biggest change/improvement since last year this time?

Pedro: Democracy of 3D printing, and having medical directors, health system, medical doctors, surgeons, engineers, bioengineers working together.

Jenny: What are you passionate about?

Pedro: My passion is the medicine, engineering, bioengineering, clinical process management: global medicine. “Learning every day”.

Jenny: What is the biggest risk you took in your career?

Pedro: One of these (“risk”) is coming next year because I will change from Vasc Health Public Service to Galician Health Public Service and it will be a new era in my career.

3D Printing Journey: 2011, 3D PMMA customized prosthesis.

Jenny: What do you enjoy in your spare time?

Pedro: I spend my time with my wife and with our friends. My wife suffered through my science inquietude, my Ph.D. study, and the time that I spent on finding patients’ solutions. She is one of my greatest support. I also enjoy watching films ever since I was younger, because they are fascinating to me and make me relaxed. My favorites include Sci-Fi, cartoon, comedy (Charles Chaplin, Buster Keaton, Oliver and Hardy, Harold Lloyd). I also enjoy listening to music and seeing Real Madrid or Spanish football team playing football.

Jenny: What else do you want to share with us? Good stories? =)

Pedro: When people in the surgical field say, “It has always been done this way”. My response is this, “If we only thought about how to drag the bags around, then nobody would have invented the wheel”. Then, this will make people stop to think about it a little.

I remember one case in which we must do a mandibular autotransplant free flap, the idea was a fibular free flap, but the patient had chronic lymphedema in his legs. We could not find any case like this in the literature. Then, I spoke with several trauma colleagues and learned that other colleagues had experiences in treating upper arm fractures in patients after mastectomy and axillary lymph nodes dissection. They said that complication rate in their hands using osteosynthesis plates were low, and we extrapolated the information and made mandibular reconstruction with fibular free flap autotransplant. The result of that case was successful.

I am happy when I see the patients happy with successful results, but when the results are not good I try to stay with these results. “Victory has a thousand fathers, but defeat is an orphan”.

2016 Best Project Award in good clinical practice. University Donostia Hospital. “2003–2017 Head and Neck Reconstruction Experience”.

Pedro would like to remember and acknowledge his Masters: R. Palomero MD. DDS., J.M. RguezCortel MD. DDS., J.A. Arruti MD. DDS., F. Gorostiaga MD.

Pedro: “Masters. Thank you very much!”

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