title: Minimally invasive repair of pectus excavatum: a novel morphology-tailored, patient-specific approach.
abstract: OBJECTIVE
  Minimally invasive repair of pectus excavatum, introduced by Nuss in 1998, has undergone a serious learning curve because of a lack of understanding on morphologies and repair techniques. To summarize the current status of minimally invasive repair of pectus excavatum, we reviewed and appraised our 10-year experience with a novel approach, a morphology-tailored technique, including diverse bar shaping, bar fixation, and techniques for adults.
  
  
  METHODS
  We analyzed the data of 1170 consecutive patients with pectus excavatum who underwent minimally invasive repair between August 1999 and September 2008. All pectus repairs were performed by the primary author (H.J.P.) with our modified technique.
  
  
  RESULTS
  The mean age was 10.3 years (range, 16 months to 51 years). There were 331 adult patients (>15 years) (28.3%). A total of 576 patients (49.2%) had bar removal after a mean of 2.5 years (range, 10 days to 7 years). The asymmetry index change (1.10-1.02, P < .001) demonstrated post-repair symmetry. Complication rates decreased through the 3 time periods (1999-2002 [n = 335]; 2003-2005 [n = 441]; 2006-2008 [n = 394]) as follows: pneumothorax rate (7.5% vs 4.3% vs 0.8%; P < .001) and bar displacement rate (3.8% vs 2.3% vs 0.5%; P = .002). Reoperation rate also decreased (4.8% vs 2.5% vs 0.8%; P = .002). Satisfaction outcomes were excellent in 92.7%, good in 5.9%, and fair in 1.4% of patients. After bar removal, 3 patients (0.6%) had minor recurrences.
  
  
  CONCLUSIONS
  Minimally invasive repair of pectus excavatum based on a novel morphology-tailored, patient-specific approach is effective for quality repair of the full spectrum of pectus excavatum, including asymmetry and adult patients. Continuous technical refinements have significantly decreased the complication rates and postoperative morbidity.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Ansan, Korea. hyjpark@korea.ac.kr
authors.forename: Hyung Joo
authors.initials: HJ
authors.lastname: Park
authors.forename: Jin Yong
authors.initials: JY
authors.lastname: Jeong
authors.forename: Won Min
authors.initials: WM
authors.lastname: Jo
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Shin
authors.forename: In Sung
authors.initials: IS
authors.lastname: Lee
authors.forename: Kwang Taik
authors.initials: KT
authors.lastname: Kim
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D017060:Patient Satisfaction; D011030:Pneumothorax / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D019736:Prostheses and Implants; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods; D055815:Young Adult