Minimally invasive pectus excavatum surgery: nuss procedure

Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach. Case report An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed.All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result. Conclusion Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.

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Lung Middle Lobe Laceration Needing Lobectomy as Complication of Nuss Bar Removal

Case Reports in Orthopedics ◽

10.1155/2018/8965641 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Brice Henry ◽

Valérie Lacroix ◽

Thierry Pirotte ◽

Pierre-Louis Docquier

Keyword(s):

Minimally Invasive ◽

Potential Risk ◽

Postoperative Period ◽

Pectus Excavatum ◽

Invasive Procedure ◽

Middle Lobe ◽

Nuss Procedure ◽

Minimally Invasive Procedure ◽

Right Middle Lobe ◽

Risk For Bleeding

Minimally invasive procedure for the treatment of pectus excavatum as described by Nuss has been used from 1987. The bar initially introduced blindly is now introduced under thoracoscopic control to increase safety of the procedure. It is usually removed two to three years after its insertion in a one-day procedure. Complications of the bar removal are rare but potentially serious. We report the case of a serious complication which occurred immediately after the Nuss bar removal. A 15-year-old boy underwent a Nuss procedure for a severe pectus excavatum without relevant complication. The bar has been removed two years after its insertion in a minimally invasive procedure. Unfortunately, he developed in the immediate postoperative period a hemopneumothorax due to a right middle lobe laceration which required a middle lobectomy by thoracotomy for hemostasis. Lesions of intrathoracic organs are a rare but potentially serious complication of the removal of the Nuss bar. We now propose to perform this procedure under thoracoscopic control to avoid it. In our experience, adhesions between the bar and the pleura are always present, and those with potential risk for bleeding or inducing intrathoracic organ lesions are suppressed prior to the bar removal.

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Development and Properties of a New Correction Instrument of Pectus Excavatum

Materials Science Forum ◽

10.4028/www.scientific.net/msf.610-613.1327 ◽

2009 ◽

Vol 610-613 ◽

pp. 1327-1330

Author(s):

Yu Ling Hu ◽

Xue Bao Yu ◽

Wei Dong Miao ◽

Gang Liu

Keyword(s):

Mechanical Properties ◽

Minimally Invasive ◽

Pectus Excavatum ◽

Testing Machine ◽

Pure Titanium ◽

Material Testing ◽

Invasive Technique ◽

Nuss Procedure ◽

Universal Material Testing Machine ◽

Material Testing Machine

A new correction instrument of pectus excavatum is introduced which is designed for a minimally invasive technique (Nuss procedure). The instrument was made of pure titanium plates, and finished by machining, surface treatment and so on. The instrument was made up of correcting bar and fixing bar. The mechanical properties of the instrument was measured with electron universal material testing machine, the safety and validity was verified by clinical doctors after being implanted into the patient. Results showed that the mechanical properties of the instrument keep constantly after implantation for two years. It is lighter than the like product, and can lighten the patent’s and the doctor’s operation bearing. It had been applied in national hospitals, and results showed that it was of better biocompatibility, and few complications were found. Clinical treatment effects were satisfactory.

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Sternal elevation techniques during the minimally invasive repair of pectus excavatum

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz142 ◽

2019 ◽

Vol 29 (4) ◽

pp. 497-502 ◽

Cited By ~ 1

Author(s):

Frank-Martin Haecker ◽

Thomas Krebs ◽

Gregor J Kocher ◽

Ralph A Schmid ◽

Sergio B Sesia

Keyword(s):

Side Effects ◽

Minimally Invasive ◽

Pectus Excavatum ◽

Skin Incision ◽

Technical Equipment ◽

Nuss Procedure ◽

Review Of The Literature ◽

Different Types ◽

Pectus Bar ◽

Number Of Authors

Summary The aim of the review was to evaluate the routine use of sternal elevation techniques (SETs) during minimally invasive repair of pectus excavatum (MIRPE, the Nuss procedure). We performed a review of the literature between January 1998 and September 2018 with focus on different methods of SET during MIRPE. Reported effects and side effects were evaluated and compared with our own experience concerning the routine use of the vacuum bell for sternal elevation during MIRPE during the last 13 years. SET is more often used in adult patients than in adolescents. SET improves visualization and safety of MIRPE. Advancement of the pectus introducer, retrosternal dissection and placement of the pectus bar are easier. The risk of cardial and/or pericardial lesion is reduced significantly. Different types of retractors, a crane combined with a wire and/or customized hooks are reported to be used as SET. Furthermore, routine use of a subxiphoid incision is reported. However, more technical equipment, and in some SETs additional incisions are necessary. In contrast, no additional skin incision is necessary for the vacuum bell. The routine intraoperative use of the vacuum bell was safe and effective in 131 patients. It facilitates the retrosternal dissection and the insertion of the pectus bar like other SETs. Besides a temporary mild hematoma, no relevant side effect was observed. In conclusion, an increasing number of authors report on the routine use of SET during MIRPE to improve safety of the procedure. We recommend the routine intraoperative use of the vacuum bell during MIRPE.

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