New endoscopic minimal access pectus carinatum repair using subpectoral carbon dioxide.
OBJECTIVE
This study establishes a minimal access hybrid technique for pectus carinatum repair. Based on 132 conventional repairs (1984-2000) and our own endoscopic technique for correcting prominent costal arches, the conventional carinatum repair was adapted to an endoscopic-assisted technique.


METHODS
Inserting two submuscular trocars and inflating CO2, the entire ventral thoracic wall was dissected endoscopically detaching pectoral muscles from ribs and sternum. February 2001 to February 2004, we repaired 37 patients (32 male) of 16.8 +/- 4.3 years (12 to 36 years). Endoscopic-assisted rib resection and axial reanastomosis, transsternal struts, and sternotomies were performed semi-open from a 2.9 to 4.7 cm incision.


RESULTS
All were completed minimally invasively, one seroma was managed conservatively. Thirty-three patients rated their result as excellent, 4 as good with a follow-up of 29.1 +/- 9.5 months (range, 18 to 55 months). Twenty-one struts were removed with no recurrence.


CONCLUSIONS
Minimal access pectus carinatum repair is safe, effective, and offers high comfort for the patient. The results are at least as good as conventional repairs, but hospital stays could be halved. Encouraging results of this early experience warrant further evaluation by other centers.
Helios Center of Pediatric and Adolescent Surgery, Berlin-Buch, Berlin, Germany. kschaarschmidt@berlin.helios-kliniken.de
Klaus
K
Schaarschmidt
Andreas
A
Kolberg-Schwerdt
Michael
M
Lempe
Frank
F
Schlesinger
D000293:Adolescent; D000328:Adult; D002245:Carbon Dioxide / Q000627:therapeutic use; D002648:Child; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D035441:Thoracic Wall / Q000002:abnormalities* / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*
D002245:Carbon Dioxide