title: Minimally invasive endoscopic repair of pectus excavatum.
abstract: OBJECTIVE
  We report our initial 3 years 4 months' single institution experience in 31 consecutive patients with pectus excavatum treated with minimally invasive endoscopic pectus excavatum repair utilizing a modification of the 'Nuss' technique.
  
  
  METHODS
  Under general anesthesia, a curved steel bar is individually shaped for each patient to match the ideal chest wall shape and is placed through an endoscopically created retrosternal tunnel between two bilateral midaxillary line 2-cm incisions. The tunnels initially go along the outside of the rib cage, under the pectoral muscles. At the level of the sternum, these tunnels go retrosternal and communicate with each other. The steel bar is passed with the convexity facing posteriorly, within a protective flat silastic drain. Under endoscopic guidance, the curved steel bar is passed through one tunnel, under the sternum, and out the other tunnel. Once positioned, the bar is turned over, thereby correcting the deformity. An epidural catheter provides perioperative pain relief.
  
  
  RESULTS
  Minimally invasive endoscopic pectus excavatum repair has been performed on 31 patients (age: range 4.4-31.0 years, median 15.0 years, mean 14.5 years). Median hospital length of stay is 4 days (range 3-10 days, mean 4.6 days). Pneumothorax occurred in five patients requiring tube thoracostomy in three. One patient developed delayed bilateral pleural effusions requiring drainage. Two patients developed evidence of sterile seroma formation at the skin incision several months after minimally invasive repair of pectus excavatum. These seromas resolved with non-interventional conservative medical treatment. No other complications occurred.
  
  
  CONCLUSIONS
  The minimally invasive endoscopic pectus repair is safe and effective and currently our procedure of choice for primary pectus excavatum in all ages. Endoscopic visualization facilitates the safe creation of the retrosternal tunnel. Short-term results have been excellent. Further follow-up will be necessary to determine long-term results.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, All Children's Hospital/University of South Florida College of Medicine, Cardiac Surgical Associates, 603 Seventh Street South, Suite 450, St. Petersburg, FL 33701, USA. jeffjacobs@msn.com
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.forename: James A
authors.initials: JA
authors.lastname: Quintessenza
authors.forename: Victor O
authors.initials: VO
authors.lastname: Morell
authors.forename: Luis M
authors.initials: LM
authors.lastname: Botero
authors.forename: Hugh M
authors.initials: HM
authors.lastname: van Gelder
authors.forename: Christo I
authors.initials: CI
authors.lastname: Tchervenkov
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D010996:Pleural Effusion / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology