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Innovative surgery for the world of medicine was performed in Bulgaria. In November cardiac surgeons at the clinic in Sofia implanted a rib that was made on a 3DGence 3D printer. This is one of the first case in the world.


Medical 3D printing

A team of doctors from the Tokuda Hospital applied an innovative method of replacing neoplastically changed bones in the treatment of a 35-year-old patient, who had a tumor formation in the rib. Ivaylo Josifov has been actively involved in the sport for many years and has never had any health problems before.

During tonsillitis, the doctors controlled the patient’s referral to lung X-rays. To their surprise, it turned out that the man suffers from a progressive deformity in the area of the fifth right rib, accompanied by swelling and pain. It was a congenital disease that could lead to a weakening of the chest and problems associated with a physical strain like difficulty breathing.

Rib implant made on a 3DGence 3D printer

Studies have shown that the best solution, in this case, is to remove the bone and replace it with an implant because of the risk that the disease could expand. Doctors decided to choose 3D printing technology because it guarantees a perfect representation of the original rib shape, both in terms of its thickness and curvature. Absolute anatomical compatibility and precision of the implant were required, that is why the rib could be reconstructed using 3D printing technology.

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

Filip Turzyński, Quality Development Manager at 3DGence.

On the right side – the patient, Ivaylo Josifov, on the left side – the cardiac surgeon


3DGence distributor in Bulgaria prepared the model of the rib for 3D printing

The work on the rib implant started with an initial 3D visualization, the bone was scanned at the hospital and the scan was delivered to 3dbgprint. This Bulgarian company adjusted the 3D model and prepared it for 3D printing. It was important that the rib should anatomically fit into the other structures of the chest wall to ensure correct reconstruction. The rib implant was made using flexible and durable polyamide, certified by the FDA (American Food and Drug Administration).

When we had the first model ready, we started working on its sturdiness. Each consecutive model was analyzed and improved until we attained the perfect 3D print of the rib

Georgi Tolev from 3dbgprint

3D printed rib with the support structures


Rib sterilization process

Before the implantation in the human body, 3 mm holes were drilled in the 3D printed model to facilitate broaching and proliferation of connective tissue. The model of the rib was properly sterilized in ethylene oxide. Moreover, the printout was also sterilized using gamma radiation and autoclaved at 140 °C.

After the operation, the patient is in perfect health and the doctors are already planning new projects using implants printed in 3D technology. This time they intend to create an implant of 3 ribs with a sternum.


This is a new era in thoracic wall reconstruction for patients with tumors that require bone-cartilage structures to be removed. 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.

Prof. Minchev, Head of the Cardiothoracic Surgery Department at Tokuda Hospital


Want to know more about medical 3D printing? Write an email to [email protected], our experts will contact you and answer all your questions.


Photo gallery:


On the right side – 3D printed rib with the support structures, on the left side – 3D printed rib after removing the support



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