title: Experience in minimally invasive Nuss operation for 406 children with pectus excavatum.
abstract: BACKGROUND
  This study was to investigate the advantages of thoracoscopy-assisted minimally invasive Nuss operation for the treatment of pectus excavatum (PE) in children.
  
  
  METHODS
  A total of 406 patients with PE (female: 93; male: 313) with an average age of 6.8 years (range: 3.5-17.5 years) were included in this study. Associated diseases included congenital heart disease in 9 patients and congenital pulmonary cyst in 2. The Haller index of the patients ranged from 3.35 to 7.23, with an average of 5.17±1.64. Minimally invasive Nuss operation was performed for all the patients.
  
  
  RESULTS
  The operations were performed successfully and no operative mortality occurred. The average blood loss during the operation was less than 10 mL and the operating time ranged from 30 to 85 minutes with an average of 45 minutes. The length of hospital stay ranged from 5 to 9 days with an average of 7 days. Struts were implanted in 12 (3.0%) of the 406 patients. Injury of the pericardium occurred in 1 patient during the operation. Early post-operative complications occurred in 9 patients with pneumothorax and 6 patients with pleural effusion, which were cured by puncture or drainage. Poor wound healing occurred in 4 patients (1.0%) and was cured by nutritional support. During a 3-month to 6-year follow-up, 2 patients had scoliosis and 3 patients had displacement of the strut, which was cured by a second Nuss operation. Allergy occurred in 2 patients: the symptoms were improved in 1 patient after conservative treatment, but the strut was removed in advance due to allergy in the other patient. Totally 154 patients (40.0%) underwent operation for strut removal. Excellent repair results were achieved in 387 (95.3%) patients, good repair results in 12 (3.0%), and fair results in 7 (1.7%).
  
  
  CONCLUSIONS
  Thoracoscopy-assisted Nuss operation has many advantages including small and masked incision, short operative time, minimal blood loss, fast recovery, less trauma, and satisfactory outcomes of repair. Nuss is a safe and reliable technique for repair of PE.
authors.affiliation: Department of Cardiothoracic Surgery, Children's Hospital, Zhejiang University School of Medicine, and Zhejiang Key Laboratory for Diagnosis and Treatment of Neonatal Diseases, Hangzhou, 310003, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Shu
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Shi
authors.forename: Wei-Ze
authors.initials: WZ
authors.lastname: Xu
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Li
authors.forename: Ze-Wei
authors.initials: ZW
authors.lastname: Zhang
authors.forename: Ru
authors.initials: R
authors.lastname: Lin
authors.forename: Xiong-Kai
authors.initials: XK
authors.lastname: Zhu
authors.forename: Jian-Gen
authors.initials: JG
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D013906:Thoracoscopy