Join us   Log in  


Pages: 1184-1188
Print Article   Download XML  Download PDF

The Contribution of 3D Printing in the Minimally Invasive Surgery of Pectus Excavatum:

A Report Case of The First Experience of A Moroccan Center

Author: N. El hajjami, M.Lakranbi, A. Aboutajjedine, M. Tachaouine, B. Alami, M. Maaroufi, Y.Ouadnouni , M. Smahi

Category: JMSR Surgery


Introduction: Pectus excavatum is a congenital deformity of the chest wall, seemingly related to abnormal cartilage growth in the costochondral region. Minimally invasive repair, as described by Donald Nuss, has become the gold standard therapeutic approach. This procedure relies on metallic bars of which the number, length and insertion site are adapted to each patient, following precise radiological data; the results depend heavily on the surgeon’s experience. The authors report a case of the minimally invasive repair of pectus excavatum using 3D printing. Report Case: A 16 years old child, with a 2-year funnel chest deformity and a history of exertional dyspnoea and symptoms of clinical depression presented with an asymmetrical pectus excavatum of the lower sternum and a right sternal rotatory deviation. Spirometry showed a restrictive ventilatory defect. Digital simulation, using images from a computed tomography segmentation of the chest wall, allowed a tailored printing of the bars prototype to the length and shape required to correct the defect. The patient underwent a Nuss procedure using a crossed-bar system, with excellent clinical and esthetical outcomes. Discussion: The use of 3D printing in the Nuss procedure ensures better planning, through an early adjustment of the bars and a preoperative detection of both bar insertion and exit bar sites. 3D printing allowed us to repair the deformity using only two-bars implant. Following the conventional procedure would have required three parallel bars, thus cutting costs in a low-revenue country. Conclusion: The pre-operative 3D conception of the chest wall’s deformity and the bar’s measurements helps simulate and adequately plan the surgical procedure. Therefore, reducing surgical time and creating pedagogical support for surgeons training.

Keywords: Pectus excavatum, chest wall, 3D printing, Morocco




  1. Sharma G, Carter YM. Pectus Excavatum. StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.
  2. Nuss D, Kelly RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998;33:545–52.
  3. Robert E Kelly 1, Michael J Goretsky, Robert Obermeyer, Marcia Ann Kuhn, Richard Redlinger, Tina S Haney, Alan Moskowitz, Donald Nuss. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg 2010;252:1072–81.
  4. R. Kabbaj, M. Burnier, R. Kohler, N. Loucheur, R. Dubois, J.-L. Jouve. Correction mini-invasive du pectus excavatum selon la technique de Nuss chez l’enfant et l’adolescent : indications, résultats, et limites. Revue de chirurgie orthopédique et traumatologique 100 (2014) 458–463.
  5. Pilegaard HK. Short Nuss bar procedure. Ann Cardiothorac Surg 2016;5(5):513-518.
  6. Hyung Joo Park 1, Jin Yong Jeong, Won Min Jo, Jae Seung Shin, In Sung Lee, Kwang Taik Kim, Young Ho Choi. Minimally invasive repair of pectus excavatum: a novel morphology-tailored, patient-specific approach. J Thorac Cardiovasc Surg 2010;139:379-86.
  7. Park HJ. A technique for complex pectus excavatum repair: the cross-bar technique for grand canyon type deformity (Park classification). Ann Cardiothorac Surg 2016;5(5):526-527.
  8. M. Gaspar Pérez, B. Núñez García, N. Álvarez García, F. Fillat-Gomà, S. Coderch-Navarro, N. Monill-Raya,C. Esteva Miró, J.E. Betancourth Alvarenga, J. Jiménez Gómez, S. Santiago Martínez, B. San Vicente Vela, P. Jiménez-Arribas, J.R. Güizzo. Initial experience with 3D printing in the use of customized Nuss bars in pectus excavatum surgery. Cir Pediatr. 2021; 34: 186-190.
  9. Kuan-Hsun Lin, Yi-Jhih Huang, Hsiang-He Hsu, Shih-Chun Lee, Hsu-Kai Huang, Ying-Yi Chen, Hung Chang, MD, Jia-En Chen, BS, and Tsai-Wang Huang.3D printing for NUSS procedure simulaion. Ann Thorac Surg 2018;105:413–7
  10. Abdul Aleem Mohammeda, Mohammed S. Algahtania, Mohammad Zaki Ahmada, Javed Ahmada, Sabna Kottab. 3D Printing in medicine: Technology overview and drug delivery applications. Annals of 3D Printed Medicine 4 (2021) 100037.
  11. L Krauel, A Tejo-Otero, F Fenollosa-Artés. 3D-Printing in surgery: Beyond bone structures. A review. Annals of 3D Printed Medicine 4 (2021) 100039.
  12. Jackson K. S. Kwok, Rainbow W. H. Lau, Ze-Rui Zhao, Peter S. Y. Yu, Jacky Y. K. Ho, Simon C. Y.
    Chow, Innes Y. P. Wan, Calvin S. Multi-dimensional printing in thoracic surgery: current and future
    applications. J Thorac Dis 2018;10(Suppl 6):S756-S.
  13. Erik R. de Loos, Jean H. T. Daemen, MD, Nadine A. Coorens, MSc, Jos G. Maessen, Yvonne L. J. Vissers and Karel W. Hulsew. Sternal elevation by the crane technique during pectus excavatum repair: A quantitative analysis. JTCVS Tech. 2021 Oct; 9: 167–175.
  14. Lai JY, Wang CJ, Chang PY. The measurement and designation of the pectus bar by computed tomography. J Pediatr Surg 2009;44:2287–90.