Addition of Thoracoscopy to Nuss Pectus Excavatum Repair

Abstract

Background and Purpose: Traditional repair of pectus excavatum (PE) has required a long and complex procedure with multiple rib resections and a large sternal scar. A minimally invasive procedure (the Nuss procedure) has recently been reported as an alternative method for PE repair. This operation involves blind passage of a clamp and rigid bar across the mediastinum, subjecting the patient to potential injury. The addition of thoracoscopy to this procedure is described in this report. Patients and Methods: During the 15 months from September 1998 to January 2000, we performed 32 PE repairs using the minimal access technique with thoracoscopic assistance. The thoracoscope is inserted into the right side of the chest for viewing during the repair. In three cases, bilateral thoracoscopy was performed. The patients ranged in age from 5 to 18 (average 10.7) years. Results: Thirty-one patients had one bar inserted under thoracoscopic guidance. One patient required two bars. The average operative time was 68 minutes (range 40-85 minutes). The average length of hospital stay was 4.7 days (range 3-8 days). There were no procedure-related complications. Two older patients have had pain with specific activity, but follow-up of 3 to 18 months has revealed no significant complications. Conclusions: Thoracoscopically assisted PE repair is a safe technique, decreasing the risk of cardiothoracic injury and other potential complications. This addition to the Nuss procedure does not lengthen the operative time, alter the cosmetic result, or increase the cost to the patient. Using thoracoscopic guidance also can facilitate learning and promoting the Nuss technique of PE repair.