title: Bilateral endoclose approach for the stabilization of the bar in pectus repair.
abstract: BACKGROUND
  Mini-invasive repair of pectus excavatum with Nuss technique is the preferred technique in most centers. One of the most important technical points for the final result is the stabilization of the bar, usually obtained by one or more stabilizers and few stitches fixing the bar to some ribs. Our aim is to show how to get the bar more stable by passing bilaterally some stitches around the bar and the ribs close to it. By a right thoracoscopy and a 30-degree optic, we are able to pass the stitches bilaterally by using an Endoclose needle (Covidien Ltd., Hamilton HM, Bermuda). The left hemithorax is visualized from the right side, pushing the optic through the mediastinum following the bar and staying just below it.
  
  
  METHODS
  We have operated on 230 patients in two centers. We have used only one stabilizer in more than 90% of the patients. In all patients, we have passed four absorbable stitches on the right side, using an Endoclose needle. In the last 45 cases, we have adopted bilateral fixation of the bar by the Endoclose needle.
  
  
  RESULTS
  The maneuver takes only around 10 minutes. We did not have complications related to that maneuver. We did not observe destabilization of the bar in those cases. The overall destabilization rate was 1.3%.
  
  
  CONCLUSIONS
  We suggest this technique to give the bar more stability on both sides. We think the use of a bilateral stabilizer can be avoided.
authors.affiliation: Department of Pediatric Surgery, G. Gaslini Institute, Genova, Italy. micheletorre@hotmail.com
authors.forename: Michele
authors.initials: M
authors.lastname: Torre
authors.forename: Patricio
authors.initials: P
authors.lastname: Varela
authors.forename: Caterina
authors.initials: C
authors.lastname: Asquasciati
authors.forename: Maria Victoria
authors.initials: MV
authors.lastname: Romanini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Jasonni
mesh_terms: D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D009339:Needles; D019616:Thoracic Surgical Procedures / Q000379:methods; D013906:Thoracoscopy