title: Intraoperative use of the vacuum bell for elevating the sternum during the Nuss procedure.
abstract: OBJECTIVE
  To evaluate the routine use of the vacuum bell for elevating the sternum during minimally invasive repair of pectus excavatum (MIRPE) (the Nuss procedure).
  
  
  METHODS
  This was a retrospective evaluation of a prospective database including all patients who underwent MIRPE at our institution between 2005 and 2010. Data included the patient's demographic characteristics, age at surgery, gender, Haller index, duration of surgery, and intraoperative complications.
  
  
  RESULTS
  Fifty patients from 9 to 28 years old (average, 14.95 years) were observed, including 39 males and 11 females. The preoperative Haller index was between 3.25 and 7.4 (average, 5.05). Mean duration of surgery was 58 minutes (range, 45-92 minutes). The use of the vacuum bell led to a clear elevation of the sternum as confirmed by thoracoscopy. Advancement of the pectus introducer and placement of the pectus bar were safe, successful, and uneventful in all patients. No cardial and/or pericardial lesion was noted as well as no lesion of the mammary vessels.
  
  
  CONCLUSIONS
  The intraoperative use of the vacuum bell during the MIRPE is safe and effective as it facilitates the retrosternal dissection and the insertion of the pectus bar. If available, we recommend the routine use of this device for MIRPE.
authors.affiliation: Division of Pediatric Surgery, University Children's Hospital Basel, University of Basel, Basel, Switzerland. frankmartin.haecker@ukbb.ch
authors.forename: Frank-Martin
authors.initials: FM
authors.lastname: Haecker
authors.forename: Sergio Bruno
authors.initials: SB
authors.lastname: Sesia
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D056346:Sternotomy / Q000295:instrumentation*; D013249:Sternum / Q000002:abnormalities* / Q000601:surgery*; D013906:Thoracoscopy; D016896:Treatment Outcome; D014618:Vacuum