title: Decreased risk of complications with bilateral thoracoscopy and left-to-right mediastinal dissection during minimally invasive repair of pectus excavatum.
abstract: BACKGROUND
  The repair of pectus excavatum using minimally invasive surgery is widely gaining acceptance as an equal if not superior technique to the traditional open approach. A number of modifications to the original Nuss procedure have been proposed to avoid complications.
  
  
  OBJECTIVE
  The aim of the study was to confirm the efficacy and safety of left-to-right mediastinal dissection during a Nuss procedure.
  
  
  METHODS
  A retrospective review of modified thoracoscopic Nuss repairs of pectus excavatum done at the Children's Hospital Oakland over approximately a 5-year period with subsequent data analysis was performed.
  
  
  RESULTS
  Thirty-two patients between the ages of 3 and 19 underwent a modified Nuss procedure using bilateral thoracoscopy and left-to-right mediastinal dissection. No intra- or postoperative complications were noted in any of the patients, which included but were not limited to mediastinal injury, bleeding, or chest tube insertion for pneumothorax.
  
  
  CONCLUSIONS
  Bilateral thoracoscopic repair of pectus excavatum with left-to-right mediastinal dissection is a safe alternative to the traditional approach, as it allows a more complete visualization of the mediastinum and eliminates the need for additional safety measures such as subxiphoid dissection and elevation.
authors.affiliation: Department of Surgery, University of California San Francisco-East Bay, Oakland, California, USA.
authors.forename: B
authors.initials: B
authors.lastname: Palmer
authors.forename: S
authors.initials: S
authors.lastname: Yedlin
authors.forename: S
authors.initials: S
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008482:Mediastinum / Q000601:surgery*; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods*