LactoSorb stabiliser is safe and effective for stabilising the bar in pectus surgery. We suggest its routine use as it appears to be less traumatic and could make bar removal easier.

The removal of the substernal bar after the Nuss operation is not always an easy and fast maneuver. Only a few different technical solutions have been described. In the original Nuss technique, the patient was lying on dorsal decubitus and rotated on the side during the procedure. The Noguchi technique avoids the rotation of the patient, but requires two incisions and straightening of the bar before pulling it out the thorax. Recently, another technique was proposed, avoiding the need of straightening the bar, but it is feasible only if two operative beds in a large operative room are available. We propose another approach for the removal of the bar: The patient is lying on the lateral decubitus, only one incision is performed, and the bar is pulled out along the thoracic wall. Twenty-one bars were removed by using the present approach without any complications. The advantages of our approach on the previous techniques are the single incision, no need of rotating the patient, straightening the bar, or having two operative beds. Our approach is not feasible when metallic stabilizers have been used on both sides, but in our experience, this was not necessary in order to stabilize the bar.

We set out to review our experience with resection of benign lung lesions performed using mechanical stapling devices via a muscle-sparing thoracotomy, and provide data on long-term morbidity, functional results, and quality of life (QOL). Fifty-two patients with a benign lung disorder were included in the study. All underwent a lung resection with mechanical staplers via a muscle-sparing thoracotomy. Medical records were retrospectively searched for postoperative complications. Nineteen patients (36.5%) also underwent a final follow-up including clinical examination, radiological investigations, functional tests, and assessment of QOL by a standardized questionnaire. No intra-operative complications occurred. The resection was anatomical (lobectomy) in 28 (53%) children and wedge in 25 (47%). Five cases (9.6%) required secondary surgery. Of the 19 children undergoing long-term follow-up, 3 (16%) had musculoskeletal anomalies and 6 (31.5%) respiratory symptoms. All X-rays were normal. Spirometry was abnormal in 9 cases (47.3%). QOL was excellent/good in 17 cases (89.5%) and sufficient in 2 (10.5%). An abnormal spirometric pattern was significantly more frequent in cases with a poorer QOL. In conclusion, stapled resection via a muscle-sparing thoracotomy is a good option to perform lung resections. However, a muscle-sparing approach does not avoid entirely long-term musculoskeletal complications. QOL is good in nearly 90% of cases, but respiratory symptoms and abnormal spirometric function can be found in one third and half of the patients, respectively. An abnormal spirometry is more common in patients with a poorer QOL. Systematic radiological follow-up is unnecessary.

We suggest this technique to give the bar more stability on both sides. We think the use of a bilateral stabilizer can be avoided.

Whatever surgical approach is adopted, spleen surgery is safe, effective, and reproducible. When feasible, the laparoscopic approach should be preferred to the traditional open approach, as far as efficacy and safety are similar, in order to reduce hospital stay, abdominal wall traumatism, and consequently, improve postoperative pain control and cosmetic results.