Thoracoscopic Redo of a Nuss Procedure: Tips and Tricks

Abstract

Introduction:

One of the most common indications for reoperation of pectus excavatum is bar displacement. ^{1 –5} The authors present a video of thoracoscopic redo of a Nuss procedure in a 16-year-old patient with a recurrence of pectus excavatum. She underwent a Nuss procedure 2 years before. She presented chronic pain and complaints of unsatisfactory cosmesis due to bar displacement. A redo of Nuss procedure was proposed.

Materials and Methods:

Surgery started with bar removal from its position in the fifth intercostal space. A bilateral thoracoscopy was performed with three ports (5 mm) on each side using previous scars. Multiple adhesions were identified between the visceral and parietal pleura along the pathway of the bar. Lysis of pleural adhesions was performed using electrocautery and/or blunt dissection with Endo Peanut. The new bar was inserted in the sixth intercostal space. The postoperative period was uneventful. Chest tube was removed at postoperative day 5. With 1 year of follow-up, the patient has no pain and satisfied with the aesthetic improvement.

Results and Conclusions:

This video highlights the long-term effects of a metallic bar inside the pleural space. In the case of a redo Nuss procedure, an extensive pleural lysis is required for a safe insertion of a new bar. Previous scars can be used to place the ports with no need for additional incisions.

No competing financial interests exist.

Runtime of video: 3 mins

This video was presented at the IPEG Meeting, 2015.