Comparison of the Standard vs. Thoracoscopic Extrapleural Modification of the Nuss Procedure—Two Centers’ Experiences

Abstract

Pectus excavatum is the most common congenital anterior chest wall deformity, with an incidence of 1:400 to 1:1000. Surgical strategy has evolved with the revolutionary idea of Donald Nuss, who was a pioneer in the operative correction of this deformity using minimally invasive surgery. The aim of this paper is to compare the preliminary results of pectus excavatum repair in two University Centers with a moderate number of patients using the standard Nuss procedure and its modification, the extrapleural thoracoscopic approach. The statistical analysis showed no significant difference for the patient’s age (14.52 ± 3.70 vs. 14.57 ± 1.86; p = 0.95) and the CT Haller index (4.17 ± 1.58 vs. 3.78 ± 0.95; p = 0.32). A statistically significant difference was noted for the duration of a pectus bar implant (2.16 ± 0.24 vs. 2.48 ± 0.68; p = 0.03) between the Maribor and Novi Sad Center. We report 14 complications (28%), including dislocation of the pectus bar (10%), pleural effusion (8%), wound inflammation (6%), pericarditis (2%) and an allergic reaction to the pectus bar (2%). Standard and thoracoscopic extrapleural Nuss procedures are both safe and effective procedures used to correct a pectus excavatum deformity. The choice of surgical procedure should be made according to a surgeon’s reliability in performing a particular procedure. Our study found no advantages of one procedure over the other.

Acute angle deformity: A special local lesion of chest wall bone structures

“…Because this kind of change is extremely violent, it will be difficult to be corrected. Since Nuss procedure appeared, the treatment of thoracic deformity has entered the era of minimally invasive surgery [4] . All the operations for the treatment of thoracic deformity are divided into two categories: one is for depression deformity, including Nuss procedure [4] , Wang procedure [5][6][7][8][9] and Wung procedure [10,11] ; the other is for protrusion deformity, including Abramson procedure [12] and Wenlin procedure [13][14][15][16][17][18] .…”

“…Since Nuss procedure appeared, the treatment of thoracic deformity has entered the era of minimally invasive surgery [4] . All the operations for the treatment of thoracic deformity are divided into two categories: one is for depression deformity, including Nuss procedure [4] , Wang procedure [5][6][7][8][9] and Wung procedure [10,11] ; the other is for protrusion deformity, including Abramson procedure [12] and Wenlin procedure [13][14][15][16][17][18] . From the nature of surgery, Nuss procedure [4] and Abramson procedure [12] are mechanical external force plastic surgery, while Wang procedure and Wenlin procedure are template plastic surgery [1,2] .…”

“…All the operations for the treatment of thoracic deformity are divided into two categories: one is for depression deformity, including Nuss procedure [4] , Wang procedure [5][6][7][8][9] and Wung procedure [10,11] ; the other is for protrusion deformity, including Abramson procedure [12] and Wenlin procedure [13][14][15][16][17][18] . From the nature of surgery, Nuss procedure [4] and Abramson procedure [12] are mechanical external force plastic surgery, while Wang procedure and Wenlin procedure are template plastic surgery [1,2] . It can be seen from the mechanism of surgery that Nuss procedure and Abramson procedure are indirect plastic surgery, and it is difficult to deal with local lesions.…”

Advances and Future Challenges of Minimally Invasive Surgery in Children

“…Minimally invasive surgery has become very popular over the last 30 years. Minimally invasive surgery in the pediatric population was slow to advance, but due to the development of technologies and instruments adapted to newborns and small children over the last 20 years has rapidly expanded to include all major pediatric surgical procedures in infants and children [ 3 , 4 , 7 , 8 , 9 , 10 ]. The benefits to the patient are great, but the technical hurdles are many, because of the varied size and physiology of this patient population.…”

“…Equipment and instruments used for minimally invasive procedures in the pediatric population are specially designed to allow safe access to the small abdominal or thoracic cavities, maintain an adequate working space and perform maneuvers with the same or even better safety and efficacy as in open procedures [ 4 , 7 , 8 , 10 ]. The diameter of instruments and telescopes varies from 2 to 10 mm depending on the procedure and child’s age [ 3 , 4 , 7 , 10 ].…”