Thoracoscopic cartilage resection with partial perichondrium preservation in unilateral pectus carinatum: preliminary results.
OBJECTIVE
Although minimally invasive repair of pectus excavatum has gained worldwide acceptance, treatment of pectus carinatum is mostly performed with open procedures. Different minimally invasive alternatives have been proposed in the last few years, including subpectoral CO(2) dissection and intrathoracic compression (Abramson technique), or conservative procedures, as dynamic compression system. Recently, another surgical technique has been proposed for the treatment of unilateral pectus carinatum, consisting of a thoracoscopic approach and multiple cartilage incisions. The aim of this work is to present our modification to this approach.


METHODS
We have modified this technique by introducing complete cartilage resection of all anomalous costal cartilages, performed thoracoscopically. Three thoracoscopic ports were used. Cartilage is removed progressively using a rongeur and preserving the anterior perichondrium.


RESULTS
We have performed this technique in 4 patients during the last year. Follow-up ranged from 6 to 14 months. No intraoperative or postoperative complications were observed. The results, assessed by the patients themselves, were good in 2 cases, quite good in one, and fair in the first patient of our series, who was reoperated using a classical open approach. Pain was well controlled without the need of an epidural catheter.


CONCLUSIONS
Thoracoscopic cartilage resection with perichondrium preservation can be considered as feasible alternative for the treatment of unilateral pectus carinatum.
Pediatric Surgery, Calvo Mackenna Hospital and Clinica Las Condes, Santiago 8320000, Chile.
Patricio
P
Varela
Michele
M
Torre
D000293:Adolescent; D002356:Cartilage / Q000002:abnormalities / Q000601:surgery*; D007839:Functional Laterality; D006801:Humans; D008297:Male; D009139:Musculoskeletal Abnormalities / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D012272:Ribs / Q000002:abnormalities / Q000601:surgery; D013249:Sternum / Q000002:abnormalities / Q000601:surgery; D035441:Thoracic Wall / Q000002:abnormalities* / Q000601:surgery; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome