Efficacy of left thoracoscopy and blunt mediastinal dissection during the Nuss procedure for pectus excavatum.
OBJECTIVE
The minimally invasive Nuss procedure is emerging as the preferred technique for repair of pectus excavatum. Original methods of pectus bar placement have been modified to improve safety and efficacy and avoid cardiothoracic complications. The currently reported modifications to facilitate retrosternal pectus bar placement include routine use of right thoracoscopy or a subxiphoid incision. The purpose of this article is to describe additional modifications of the Nuss procedure to improve safety and efficacy.


METHODS
A retrospective analysis was performed on 51 patients who have had a thoracoscopic-assisted Nuss procedure at The Children's Hospital, Denver, Colo, between 1999 and 2002. Technical modifications included patient positioning, routine use of left thoracoscopy, and an Endo-kittner.


RESULTS
Fifty-one patients have successfully undergone the Nuss procedure using the new modifications. Surgical time ranged from 45 to 120 minutes. There have been no intraoperative or postoperative bleeding complications. There have been 2 large pneumothoraces requiring needle thoracenteses in the operating room before extubation. No chest tubes were required postoperatively. Subjectively, all patients have been satisfied with their surgical correction. Average length of hospital stay was 4 to 6 days.


CONCLUSIONS
By using left chest thoracoscopy and Endo-kittner dissectors, the risk of cardiothoracic injury can be eliminated. Moreover, other methods to ensure safe substernal dissection are unnecessary.
Hendrickson
Richard J
RJ
Division of Pediatric Surgery, The Children's Hospital/The University of Colorado Health Science Center, Denver, CO 80218, USA. hendrickson..richard@tchden.org
Bensard
Denis D
DD
Janik
Joseph S
JS
Partrick
David A
DA
D000293:Adolescent; D002648:Child; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008482:Mediastinum / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011030:Pneumothorax / Q000209:etiology; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000295:instrumentation*; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods