title: Sparing internal thoracic vessels in thoracoscopic or submuscular correction of pectus carinatum: A porcine model study.
abstract: BACKGROUND
  External compression is used for pectus carinatum (PC) treatment, but many patients are noncompliant. Costal cartilage resection (CCR) has been described as an alternative, but these approaches sacrifice the internal thoracic arteries (ITA). We aim to assess the feasibility of CCR sparing ITA comparing thoracoscopic and subcutaneous endoscopic approaches.
  
  
  METHODS
  Twelve pigs were used as models for surgical PC correction and randomized for 2 groups: thoracoscopy (T) and subcutaneous (subpectoralis) endoscopy (SP). In both groups, CCR from 3rd 4th and 5th ribs was performed avoiding ITA damage. ITA preservation was confirmed by Doppler-ultrasound as well as postmortem injection of methylene blue. Four persons evaluated the procedures being difficult, using a 6-item modified validated scale.
  
  
  RESULTS
  In both techniques, the procedure was accomplished in all animals sparing ITAs. CCR was faster in T than in SP (49±5 vs. 65±16minutes, p<0.05). T was classified as easier than SP (p<0.001) with a significantly higher score for all items, especially better image and tissue handling.
  
  
  CONCLUSIONS
  Sparing the ITAs during CCR for correction of PC is feasible in a porcine model and might be a goal in humans. The thoracoscopic approach allows for a faster and easier procedure.
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Pediatric Surgery Department, Hospital São João, Faculty of Medicine, Porto, Portugal.
authors.forename: Ruben
authors.initials: R
authors.lastname: Lamas-Pinheiro
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mitzman
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
authors.forename: Alice
authors.initials: A
authors.lastname: Miranda
authors.affiliation: Pediatric Surgery Department, Hospital São João, Faculty of Medicine, Porto, Portugal.
authors.forename: Tiago
authors.initials: T
authors.lastname: Henriques-Coelho
authors.affiliation: Pediatric Surgery Department, Hospital São João, Faculty of Medicine, Porto, Portugal.
authors.forename: José
authors.initials: J
authors.lastname: Estevão-Costa
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; Pediatric Surgery Department, Hospital de Braga, Braga, Portugal. Electronic address: jcp@ecsaude.uminho.pt.
authors.forename: Jorge
authors.initials: J
authors.lastname: Correia-Pinto
mesh_terms: D000818:Animals; D066186:Costal Cartilage / Q000000981:diagnostic imaging / Q000601:surgery*; D023421:Models, Animal; D066166:Pectus Carinatum / Q000601:surgery*; D011897:Random Allocation; D012272:Ribs / Q000601:surgery; D013552:Swine; D013895:Thoracic Arteries; D013906:Thoracoscopy / Q000379:methods*; D018608:Ultrasonography, Doppler
keywords: Chest wall deformities; Endoscopy; Minimally invasive surgery; Pectus carinatum; Thoracoscopy