Minimally Invasive Modified Nuss Procedure for Repair of Pectus Excavatum in Pediatric Patients: Single-Centre Retrospective Observational Study

Background: The treatment of pectus excavatum can be conservative or surgical. The aim of this study was to determine the factors influencing the outcomes of treatment after a minimally invasive Nuss corrective surgery procedure in pediatric patients. Methods: A total of 30 patient who underwent a minimally invasive Nuss corrective procedure for pectus excavatum from 1 January 2014 to 31 December 2020 were included in thisretrospective study. The collected data included thepatient’s demographic characteristics (age, sex, height, weight, body mass index—BMI, Haller index), treatment outcomes (duration of surgery, length of hospital stay, intraoperative complications, early and late complications, postoperative analgesia), and overall patient and legal guardian satisfaction two years after the procedure. Results: A total of 22 male and 8 female patients were included in the study. The median age was 15 years (interquartile range—IQR 14, 16), and the median BMI was 18.5 kg/m2 (IQR 17.7, 20.4) and 18.2 kg/m2 (IQR 16.9, 18.6) for males and females, respectively. The median CT Haller index was 3.67 (IQR 3.48, 4.09) for male and 3.69 (IQR 3.45, 3.9) for female patients. The median surgery duration was 120 min (IQR 100, 130), and the median hospital stay length was 8.5 days (IQR 8, 9.75). Indications for surgery were psychological (47%), followed by respiratory (30%) and combined respiratory-cardiac (20%) and respiratory-psychological disorders (3%). Early complications were observed in 18 patients (60%), and late complications were observed in 7 patients (23.3%). Intraoperative complications were not recorded. The most common early complications were pneumothorax and subcutaneous emphysema (30%), while late complications included bar displacement (10%) and deformity recurrence (6.6%). Overall,the procedure was successful in 93.1% of patients. Upon arrival home, 22 patients (81.5%) used analgesics for at least one day, up to a maximum of six months. A total of 23 (76.7%) operated patients determined that the surgical procedure had excellent results (grade 5) , 4 (13.3%) patients report a good result (grade 4), 1(3.3%) patient reported a mediocre result, and one patient (3.3%) reported a bad result (grades 3 and 2, respectively). Conclusion: The Nuss procedure is a safe and effective method for treating funnel chest in children and adolescents. It also providesexcellent cosmetic and aesthetic results as well as subjective satisfaction with the outcome of surgical treatment.

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Minimally Invasive Thoracic Surgery in Pediatric Patients: The Taiwan Experience

BioMed Research International ◽

10.1155/2013/850840 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Yu-Kai Huang ◽

Chieh Chou ◽

Chung-Liang Li ◽

Hui-Gin Chiu ◽

Yu-Tang Chang

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Pectus Excavatum ◽

Pediatric Patients ◽

Nuss Procedure ◽

The Past ◽

Clinical Scenarios ◽

In The Beginning ◽

Minimally Invasive Thoracic Surgery ◽

Spontaneous Hemopneumothorax

Minimally invasive technology or laparoscopic surgery underwent a major breakthrough over the past two decades. The first experience of thoracoscopy in children was reported around 1980 for diagnosis of intrathoracic pathology and neoplasia. Up until the middle of the 1990s, the surgical community in Taiwan was still not well prepared to accept the coming era of minimally invasive surgery. In the beginning, laparoscopy was performed in only a few specialties and only relatively short or simple surgeries were considered. But now, the Taiwan’s experiences over the several different clinical scenarios were dramatically increased. Therefore, we elaborated on the experience about pectus excavatum: Nuss procedure, primary spontaneous hemopneumothorax, thoracoscopic thymectomy, and empyema in Taiwan.

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Back to the future: a case series of minimally invasive repair of pectus excavatum with regular instruments

Jornal Brasileiro de Pneumologia ◽

10.1590/1806-3713/e20170373 ◽

2019 ◽

Vol 45 (1) ◽

Cited By ~ 1

Author(s):

Miguel Lia Tedde ◽

Silvia Yukari Togoro ◽

Robert Stephen Eisinger ◽

Erica Mie Okumura ◽

Angelo Fernandes ◽

...

Keyword(s):

Postoperative Complications ◽

Minimally Invasive ◽

Pectus Excavatum ◽

Intraoperative Complications ◽

Case Series ◽

Cardiac Perforation ◽

Patient Demographics ◽

Haller Index ◽

Thoracic Drainage ◽

Preliminary Study

ABSTRACT Objective: Minimally invasive repair of pectus excavatum (MIRPE) is a surgical treatment for PE. During the procedure, a specialized introducer is used to tunnel across the mediastinum for thoracoscopic insertion of a metal bar. There have been reported cases of cardiac perforation during this risky step. The large introducer can be a dangerous lever in unskilled hands. We set out to determine the safety and feasibility of using regular instruments (i.e., not relying on special devices or tools) to create the retrosternal tunnel during MIRPE. Methods: This was a preliminary study of MIRPE with regular instruments (MIRPERI), involving 28 patients with PE. We recorded basic patient demographics, chest measurements, and surgical details, as well as intraoperative and postoperative complications. Results: Patients undergoing MIRPERI had Haller index values ranging from 2.58 to 5.56. No intraoperative complications occurred. Postoperative complications included nausea/vomiting in 8 patients, pruritus in 2, and dizziness in 2, as well as atelectasis, pneumothorax with thoracic drainage, pleural effusion, and dyspnea in 1 patient each. Conclusions: In this preliminary study, the rate of complications associated with MIRPERI was comparable to that reported in the literature for MIRPE. The MIRPERI approach has the potential to improve the safety of PE repair, particularly for surgeons that do not have access to certain special instruments or have not been trained in their use.

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A strategy for simulating and validating the Nuss procedure for the minimally invasive correction of pectus excavatum

2011 4th International Conference on Biomedical Engineering and Informatics (BMEI) ◽

10.1109/bmei.2011.6098771 ◽

2011 ◽

Cited By ~ 2

Author(s):

Krzysztof J. Rechowicz ◽

Frederic D. McKenzie

Keyword(s):

Minimally Invasive ◽

Pectus Excavatum ◽

Nuss Procedure

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Nuss Procedure for a Patient with Negative Haller Index

European Journal of Pediatric Surgery Reports ◽

10.1055/s-0038-1623537 ◽

2018 ◽

Vol 06 (01) ◽

pp. e18-e22 ◽

Cited By ~ 1

Author(s):

Mariela Dore ◽

Paloma Triana Junco ◽

Carlos De La Torre ◽

Alejandra Vilanova-Sánchez ◽

Monserrat Bret ◽

...

Keyword(s):

Minimally Invasive ◽

Pectus Excavatum ◽

Vena Cava ◽

Forced Expiratory Volume ◽

Exercise Intolerance ◽

Nuss Procedure ◽

Invasive Approach ◽

History Of ◽

Ventilation Pattern

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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Perioperative complications and quality of life after radical retropubic prostatectomy

Urologia Journal ◽

10.1177/039156039506201s04 ◽

1995 ◽

Vol 62 (1_suppl) ◽

pp. 19-22

Author(s):

F. Merlo ◽

M. Mangano ◽

P. Checchin ◽

L. Maccatrozzo ◽

A. Fandella ◽

...

Keyword(s):

Social Life ◽

Perioperative Complications ◽

Intraoperative Complications ◽

Late Complications ◽

Pelvic Lymphadenectomy ◽

Radical Retropubic Prostatectomy ◽

Point Of View ◽

Early Complications ◽

Retropubic Prostatectomy

— The Authors report their experience with perioperative complications in 128 patients after radical retropubic prostatectomy preceding bilateral pelvic lymphadenectomy for prostatic cancer. Patients were classified by anatomo-pathological stage; 25% were stage D1. Data relating to homologous transfusions (22%), intraoperative complications (1.6%), minor (16%) or major (7%) early complications and late complications (0.8%) are analysed. The latest group of patients has also been assessed from a sexual, psychological and social point of view. 84% of patients reported an erectile deficit, but only 4% suffered a psychological worsening reflecting on their social life.

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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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