St Thomas' and Great Ormond Street Hospital came up with the idea to take
3D copies of the kidney of dad Chris Boucher and the abdomen of his then
two-year-old daughter Lucy in an innovative step before the operation in
November last year. Speaking in their first broadcast interview, let's talk to Chris then,
his wife Cara and Lucy. Who's now turned three from their home in
Antrim in Northern Ireland and the surgeon who came up with the idea,
Pankaj Chandak is with us in the studio too. Right, good morning everybody thank you
so much for coming on the programme
Chris, Cara, just explain to us what the situation with Lucy was and why she needed a kidney transplant.
Well basically, Lucy was born healthy and everything
seemed fine right throughout pregnancy but then at four weeks old she had
massive heart failure. We basically went to lift her in the morning and she was
a ghostly white. Her lips were kind of going blue and my wife basically just bundled
her up and rushed to the hospital . Thankfully it's just about five minutes from us.
But immediately they identified that she was in massive heart failure and then
throughout that that day she was moved to the Royal in Belfast from Antrim but throughout
that day became clear they couldn't do anything for her to save her here so she
was transferred to Newcastle in England to the Freeman's heart unit and she was
put on an ECMO machine which give her heart then a chance to recover from the heart
failure but as a result of the massive heart failure and the oxygen
starvation her kidneys stopped working and didn't really start working again so
she had to basically go on daily dialysis and it was, that was the first
time actually she was involved in pioneering medical breakthroughs because a
retired kidney doctor there called Malcolm Coulthard
had just invented a machine to haemodialyse, so dialysed through the blood and
tiny children, because she was only three kilograms and at that point she needed
that machine
daily and it basically then threw a lot of ups and downs and we were in Newcastle
then for the next eight months. That machine, the Nitas machine, saved her life basically
because there was no other form of the dialysis that she could have at her size
because she also had stomach damage due to the heart failure and it had just been
recently invented and it's still in its development and Lucy actually has
helped develop that machine a good bit from what they learned off her but
basically we were there for eight months and had ongoing normal dialysis here
when she was right size for that and then up until she got to the point where
she is big enough to have the transplant which was just there in
November of last year.
Brilliantly explained Chris
That's two years in a nutshell!
Absolutely and said in such a pragmatic way Cara I wonder if it was as
straightforward as Chris has just made it sound.
No there were lots of ups and downs along the way, they were, I mean, from the day that she took ill we were
told when we're leaving our local hospital in Antrim to say goodbye to her
because she may not make the journey to Belfast which is a journey that we make
countless times in a week so there were plenty of ups and downs. There were when
they had tried, about four months after she first first took sick
to reverse her stoma and try peritoneal dialysis and that didn't work. She had too
many adhesions so at that point we were told that she had been between a rock
and a hard place and we were told that she was between a rock and a hard place
and the devil and the deep blue sea. And then down to the team that developed the
dialysis machine further.
Is she taking your temperature?
She is taking my temperature. She's turned into quite the little medic
Well worryingly she always tells me it's 85 so that can't be good! I don't know where she's got 85 from!
There have been plenty of of hard things along the way and thankfully for us you
know we have had brilliant medical teams in five different hospitals who have worked
with her I got her to where she is today when she came back from Newcastle and
was on dialysis for a full two years here and on the standard machine, she did
brilliantly on it. they would comment that she didn't act like a child on dialysis
she would go in and she'd play she was quite happy to see the nurse's. solely
Your temperature's four!
It's only four? Oh dear.
Have you said hello yet? You should say hello. Turn round. g but I'm going to
Hi Lucy! How are you? You can't see me waving but I'm going wave anyway, hello lovely.
So I mean the nurses in the Royal Hospital in Belfast really over the last two years have been
kind of more like honorary aunties to her that she seen so much during the week
So we are very fortunate yes there were lots of ups and downs that first eight
months but very fortunate that the two years that she was on dialysis three
times a week, always very straightforward.
Let me bring in transplant surgeon then
Pankaj Chandak who is sitting alongside me here. First of all Chris was
the perfect match in terms of kidney transplant for Lucy. You came up with
this idea of using a 3D printer to effectively build a replica of Chris's
kidney and Lucy's abdomen which is this why would that help you ahead of the operation?
OK well firstly we know that 3D printing technology has been used for lots of other
specialties in medicine such as cardiac surgery or maxillofacial surgery, or cancer surgery
The problem that we face in transplantation is trying to place an adult size kidney
into a small abdomen and Lucy's abdomen was about 10 kilograms
Ok, do you mind showing our audience exactly what you were trying to do?
Yes. So this is Lucy's abdomen, a print of her abdomen here.
So this is the liver. You can see that there.
That's quite soft, we can move that back.
So that's actually replicating the softness of a real liver?
Well not exactly but it's the next best thing.
You've got the two kidneys here you can see they're quite small absolutely yes and then you've got the
major blood vessels in the abdomen here the aorta and the inferior vena cava and here you've got the bony pelvis which is
actually printed in a harder material as it would be in the
human body so the printer essentially relies on information from CT scans and
MRI scans and then moulds, liquid plastic essentially, under UV light to create
these models and this is Chris's kidney adult size. You can see the size discrepancy
there and essentially it's trying to place that in the appropriate position inside Lucy's abdomen
So essentially it helps us with not only planning that approach but thinking about
our incision how we're going to approach the vessels and the best line
of the kidney inside the abdomen.
Would you have been able to do this operation without
using the 3D printed models first?
Yes, but the advantage of the model is that it allows a hands-on informative approach for the surgical team to
essentially go through the procedure in their minds actually physically
manipulating the models in real time prior to the actual procedures itself
So that's the added advantage. It's an additional layer of safety that we can offer the
patients for this complex type of surgery.
And Chris and Cara you were obviously able to hold these models, what was that like?
How did that help you with understanding how this operation was going to go?
I was just astounded by it really. At first to see the actual size of my kidney.
I had been been told in sort of tests beforehand and I'd seen scans and had
an idea of what it was, but actually to just see it in that 3D shape of what it was and
then also to see Lucy's abdomen in an exact replica and size it was just astounding, I mean
the 3D printing even prints right down to the sort of the grain if you like of
the kidney the actual texture in a sense round the side of it . So I mean it was
just phenomenal seeing it and then being able to hold it hold it over Lucy's
abdomen. You're just again with thinking how on earth can they fit into this abdomen you know?
Just again it just highlighted even more just how impressive what
what they do really is.
Well let's just ask you Pankaj, how did you fit in because the way the
way you're demonstrating in this now you have to move other organs around.
Yes so the advantage is so that we can move the liver out of the way
here and then this is the side wall of the abdomen which we can move in here
Maybe if you want to hold that up for me there,
I can show you how we placed the kidneys.
So we essentially moved the liver out of the way here.
And then we placed the kidney inside like that essentially and joined the vessels
up like that. And obviously the bowel is in the way as well
And we have to make sure that's appropriately placed back and then we have to close the abdomen.
Sometimes in very small children we may not be able to do that but in Lucy's case we were able to do that.
So that's the great advantage of the model because it helped us appreciate that anatomy.
So I can obviously that Lucy looks fab and is energetic and lively and all the rest of it
Tell us how she actually is from your point of view mum and dad.
She's brilliant. She has always had energy
But she has just boundless energy. She just jumps about the place or just kind of runs.
Two big things before the surgery, for a child on dialysis, she did continue to eat little bits, but didn't eat very much
So most of her nutrition was going through her nasal gastric tube
So since the surgery with a working kidney she's started to eat. She's not quite eating all of her calories
but she's heading in that direction.
And it's just lovely to have her just be part of meals and like we were able to take
her out for her birthday for dinner which in the past didn't really mean a
whole lot to Lucy but we're able to do that and also when
when you're on dialysis your urea, one of your blood levels can be quite high and
that can make you feel sick and Lucy would have vomited generally at least once a day
we were kind of trying to keep up with feeds and she's vomited once since the
surgery which obviously is so much better for her, it makes life a whole
lot better when you're not changing beds in the middle of the night and trying to
chase feeds so that's two massive differences and then another huge one is
last week for the first time since she was four weeks old
we were only at the hospital once whereas, well she lived in hospital for eight
months and then she's been up and down to the hospital three times a week and
then was obviously back in hospital for the transplant so yeah massive change for her
and you know what she's been so brilliant behaved and she's just starting to
get bored now I don't blame her.. ....listen I'm so grateful for your
time it's really nice to talk to you and I'm so happy for you all. Thank you very
much for coming on the programme.
Thank you and again we can't just express our gratitude
to the people, right from the beginning in
the Antrim area hospital to the people that treated her during that horrific day of
heart failure in the Royal in Belfast to the Freeman in Newcastle, the RVI in Newcastle
The Nidus machine which was invented and then because of Lucy
got reinvented to take her onto the, it used to only work up until four and a half kilograms
because of Lucy and her getting to that place where if it didn't,
if the machine didn't change then she wouldn't live. They managed to redesign it so it can take
a child of eight kilograms right up to the Royal in Belfast on dialysis and again in Great
Ormond Street and the phenomenal work with that 3D print out.
And just , I mean that helped put our mind at ease
just seeing what would be done you know and and just knowing as well just
the forward thinking minds that there are like Pankaj and like Malcolm Coulthard with
that machine. We don't really think about it enough.
In the NHS there are a lot of people here continually trying to work
to make what they, the ways in which they can treat us you know better and they did
honestly with such little funding at times and have to really struggle to do it
and the work is just phenomenal. Lucy as you see with the temperature thing
I mean, Lucy do you like hospital? She is just so happy smiles she
smiled right through it and that's because of the nurses and the staff and
the way they've been with her she she gets excited whenever she's going to the
hospital even though she's going to get blood tests which she hates. She walks out with a smile on
her face you know so we really are so grateful and to all our family and friends that supported us.
She wants to go now, she's got her bag on, she's ready. Listen thank you so much.
Pankaj thank you very much for coming on the programme as well,
and a great testament to you and your colleagues at hospitals around the UK.
nothing to do with not so much on our program code
a partial apology to Paula Radcliffe which he accepted after hearing into
doping allegations emerged linked to doping allegations she has been cleared
by the IWF he said it wasn't really anything to do with our committee
hearing the context context it will not just a really good athlete John on
Twitter
well done in defending your reputation for a dignified stance the truth will
win in the end federal health on Twitter a wonderful interview a very honest
heartfelt interview am unable to say the same thing jessye norman however Steve
on Twitter superb interview I for one have no doubt about the reckless
integrity patty his email to say it was brilliant and we trust her completely
she should be in charge of all play a major role in any committee
investigating doping how disgraceful disgraceful that the Conservative MPP
found it
possible to apologize properly his disgraceful behaviour during the
Redcliffe accused of something you've never done it's a disgrace and shouldn't
happen again
do keep those coming