NHS charities will provide the next generation of tools for life-saving operations, the surgeon who helped lead the reconstructive surgery for Malala Yousafzai has said.

Stefan Edmondson, a consultant clinical scientist at University Hospitals Birmingham (UHB) foundation trust, told i that trusts’ charitable arms have allowed doctors to work with equipment that would be unavailable through the normal NHS procurement process. His team’s work on Nobel Peace Prize laureate Malala, who was shot by the Taliban in 2012, was only made possible thanks to 3D printers funded by the UHB charity.

Speaking as a new exhibition led by NHS Charities Together, Love and Charity: A History of Giving in the NHS, opens at the Saatchi gallery in London today, Mr Edmondson said: “The [trust] charities would always support a sort of whacky, or out of the ordinary, project.

“You’re trying to do something that’s not a tried and tested method. When we went down the road of 3D printers with Malala nobody had ever done that. We were the first trust in the UK to do it [in February 2013].”

Doctors in Pakistan removed the bullet from Malala’s head after she was shot in October 2012, but the then 15-year-old’s brain swelled dangerously days after the shooting, forcing them to extract a section of her skull about the size of a hand. Otherwise, the pressure in her cranium would have caused severe brain damage, likely killing her.

Malala was given a 70 per cent chance of survival and offers to treat her came from around the world. She travelled to the UK for further treatment, approved by both her doctors and family, and was treated at the Queen Elizabeth Hospital, part of the UHB trust – one of the hospital’s specialties being the treatment of military personnel injured in conflict.

An eight-hour operation in January 2013 in order to repair her facial nerve was followed by the five-hour operation the following month to reconstruct her skull and restore her hearing with a cochlear implant.

Stefan Edmondson Malala surgeon
Stefan Edmondson, centre, said people thought he and his team were wasting their money using a 3D printer to reconstruct Malala Yousafzai’s skull helping them perform surgery on her in 2013. The machines are now used throughout the NHS (Photo: Stefan Edmondson)

3D printing allowed Malala’s operation to be so much “slicker”, Mr Edmondson said. “We got a phonecall one day and of course it was all very hush-hush. While Malala was on the plane from Pakistan we had her skull defect printed and her skull plate ready to go for when she landed in the UK.

“Before, you’d almost have to look at a CT scan, in a 2D or 3D image, we’d have had to shave her head, palpate [touch] the defect and take an impression of it. Now you print the defect off and you have a template to start manufacturing the titanium skull plate on. Almost from when she was being taxied on the tarmac we had it finished and ready to go.

“It was a case of dipping our toe in the water, and once we had that exposure a lot of hospitals have taken that lead – 3D printing in medicine now is huge. We have five at our trust now. When we first did it everyone thought we were crazy, wasting our money. But the UHB charity supported us with that. They’ll put their neck on the line to do so and that’s where NHS charities break the mould. They make great decisions and are quite visionary.”

Mr Edmondson, who also fundraises personally through half-marathons and other events, said he is now looking at securing charitable funding for desktop laser sintering – a manufacturing process that uses a laser to sinter (heating something into a coherent mass without melting) powdered metal into 3D parts from a digital 3D model – which he believes could be the next big tool in a surgeon’s armoury.

The laser selectively melts and fuses powder particles together to form a solid part. The process is used to produce parts with complex geometries and intricate details with high accuracy.

Mr Edmondson said: “We manufacture a lot of patient specific implants, whether it be for head and neck cancer reconstruction, neurosurgery – like the Malala side, or for orthopaedics. We 3D print the cutting guides as well, we surgically plan everything virtually, we pre-plan all the surgery, so the next thing would be a desktop sintering machine.

Picture by www.edwardmoss.co.uk All rights reserved QE Hospital Charities
A skull made by using a 3D printer (Photo: UHB Charity)

“It means you can design something in the software where you reconstruct somebody’s jaw with a large metal plate and we can 3D print that in the hospital as opposed to having to send it out to a commercial company or bend a straight plate. That’s the next vision. I’ve already got my fingers in a lot of pies with that.

“It’s an exciting time for technology in healthcare. You have AI [artificial intelligence], VR [virtual reality]. Augmented reality is taking things into a completely different world. We’re seeing stuff now that reminds of when I was a kid watching Space 1999 [a sci-fi show from the mid-1970s], you just think ‘wow’. The digital side of things has really come on. It has totally and utterly transformed healthcare.”

Despite all the challenges of workforce and funding, challenges that have been there throughout his career, Mr Edmondson believes the NHS remains at the forefront of medical advances.

“The NHS provides such an outstanding service. In terms of where the NHS is going in my practice and around the country, when I go to a lot of countries as I present internationally, I can proudly say that the NHS is still at the forefront of global healthcare. A lot of people don’t realise what they have on their doorstep. The NHS is such a fantastic institution.

“What I’m doing here in Birmingham and what other colleagues are doing up and down the country, still isn’t being done in the United States or in Germany. That’s where charities link in. I do think the quality of treatment in the NHS is world class. We do have challenges, everyone does, but I’m so proud of working within the NHS and the more challenges we find the more the British grit digs in and we say ‘we’ve gotta fix this’.”

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