A group of surgeons at the Tokuda Hospital in Bulgaria recently replaced a tumor-containing rib with a 3D printed prosthetic to save a patient’s life. The operating surgeon was Dr. Tzvetan Minchev, Chief of Thoracic Surgery Department at the Tokuda Hospital, and the patient saved was Ivaylo Josifov.
Josifov originally went in for a simple tonsillitis scan, but X-ray analysis revealed that the 35-year-old had a tumor in one of his ribs. This condition is a congenital disease that is known to cause serious health issues. Replacement surgery was deemed to be the best course of action in treating Josifov, however, the doctors needed to produce a replacement bone with extreme precision and accuracy.
For this reason, 3D printing was best method of fabrication. Specifically, a 3DGence printer was used to craft the replacement rib. Filip Turzyński, the company’s Quality Development Manager, said, “Our 3D printers ensure high 3D dimensional accuracy which was crucial in this particular medical procedure. Individually designed rib model allowed for a very accurate implementation of the new element in place of the removed bone. Replacing the missing rib with a 3D printed segment with the same shape, curve, width, and thickness was possible with the use of 3DGence 3D printer.”
First, the rib was 3D scanned. This 3D model was then sent to 3dbgprint where it was used to 3D print the prosthetic on a 3DGence printer. The rib was sanitized with ethylene oxide, gamma radiation, and an auatoclave, then had small holes drilled into it. These holes were used to facilitate proliferation of connective tissue.
The printer used was a fused deposition modeling (FDM) 3D printer, used to handle high-temperature materials such as the FDA-approved polyamide used for the rib. This material is semi-rigid, and ideal for prosthetics such as the rib.
“This is a new era in thoracic wall reconstruction for patients with tumors that require bone-cartilage structures to be removed,” said Dr. Minchev. “The material used has proven tissue compatibility and the accuracy of reproduction allows for large chest wall resections and their single substitution with individually designed implants.”
Dr. Minchev was the recipient of the Physician of the Year 2017 award, granted by the Bulgarian Physician Association.
It was imperative that the dimensions were accurate to the patient’s rib, but the rib’s specific flexibility was equally important as well. “When we had the first model ready, we started working on its sturdiness,” said Georgi Tolev of 3dbgprint. “Each consecutive model was analyzed and improved until we attained the perfect 3D print of the rib.”
Overall the operation went very well, and Josifov is in good health. This was Bulgaria’s first operation involving a 3D rib implantation. The Tokuda doctors have future plans to use 3D printing to create three ribs that connect to a sternum.
— Berci Meskó, MD, PhD (@Berci) December 23, 2018