title: 3D printing of surgical instruments for long-duration space missions.
abstract: BACKGROUND
  The first off-Earth fused deposition modeling (FDM) 3D printer will explore thermoplastic manufacturing capabilities in microgravity. This study evaluated the feasibility of FDM 3D printing 10 acrylonitrile butadiene styrene (ABS) thermoplastic surgical instruments on Earth.
  
  
  METHODS
  Three-point bending tests compared stiffness and yield strength between FDM 3D printed and conventionally manufactured ABS thermoplastic. To evaluate the relative speed of using four printed instruments compared to conventional instruments, 13 surgeons completed simulated prepping, draping, incising, and suturing tasks. Each surgeon ranked the performance of six printed instruments using a 5-point Likert scale.
  
  
  RESULTS
  At a thickness of 5.75 mm or more, the FDM printing process had a less than 10% detrimental effect on the tested yield strength and stiffness of horizontally printed ABS thermoplastic relative to conventional ABS thermoplastic. Significant weakness was observed when a bending load was applied transversely to a 3D printed layer. All timed tasks were successfully performed using a printed sponge stick, towel clamp, scalpel handle, and toothed forceps. There was no substantial difference in time to completion of simulated surgical tasks with control vs. 3D printed instruments. Of the surgeons, 100%, 92%, 85%, 77%, 77%, and 69% agreed that the printed smooth and tissue forceps, curved and straight hemostats, tissue and right angle clamps, respectively, would perform adequately.
  
  
  CONCLUSIONS
  It is feasible to 3D print ABS thermoplastic surgical instruments on Earth. Loadbearing structures were designed to be thicker, when possible. Printing orientations were selected so that the printing layering direction of critical structures would not be transverse to bending loads.
authors.forename: Julielynn Y
authors.initials: JY
authors.lastname: Wong
authors.forename: Andreas C
authors.initials: AC
authors.lastname: Pfahnl
mesh_terms: D000180:Acrylic Resins; D000337:Aerospace Medicine; D002070:Butadienes; D017076:Computer-Aided Design; D005240:Feasibility Studies; D006801:Humans; D008422:Materials Testing; D008961:Models, Structural; D010969:Plastics; D011137:Polystyrenes; D011327:Printing / Q000379:methods*; D012984:Software; D013026:Space Flight; D013525:Surgical Instruments
chemical_list: D000180:Acrylic Resins; D002070:Butadienes; D010969:Plastics; D011137:Polystyrenes; C024636:ABS resin