title: A new sternum elevator reduces severe complications during minimally invasive repair of the pectus excavatum.
abstract: BACKGROUND
  Although the Nuss procedure for pectus excavatum is widely employed, a variety of complications have been reported with relatively high frequency; those that involve cardiac and pericardial injuries can be life threatening. To reduce such dangers, we present here a newly developed sternal elevator.
  
  
  METHODS
  The elevator is horseshoe shaped. Its elevator side has the same curvature as a Nuss introducer, so that interference between devices is minimal and no extra skin incision is needed for the elevator insertion. The elevator holds the sternum forward and enlarges the retrosternal space for safer passage of thoracoscopically guided introducer.
  
  
  RESULTS
  The authors have used the elevator for 61 pectus excavatum cases between March 2004 and December 2009 without any major complications. The entire process of substernal tunneling was endoscopically observed, which eliminated any blunt and blind dissection, even in a significantly depressed funnel chest case. With the device, the sternum was effectively elevated again for the placement of the second plate in 30 cases.
  
  
  CONCLUSIONS
  Our newly developed sternum elevator makes the Nuss procedure safer and more affordable without introducing any extra scarring.
authors.affiliation: Department of Plastic, Reconstructive, and Aesthetic Surgery, School of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan. stakagi@fukuoka-u.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takagi
authors.forename: Takuto
authors.initials: T
authors.lastname: Oyama
authors.forename: Nishihira
authors.initials: N
authors.lastname: Tomokazu
authors.forename: Koji
authors.initials: K
authors.lastname: Kinoshita
authors.forename: Taro
authors.initials: T
authors.lastname: Makino
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ohjimi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D019637:Orthopedic Procedures / Q000295:instrumentation*; D012720:Severity of Illness Index; D013249:Sternum; D055815:Young Adult