Endoscopic Correction of Pectus Excavatum

Abstract

Endoscopic surgery is minimally invasive and can be used to achieve superior cosmetic results. Conventional correction of pectus excavatum results in a long scar. Correction by use of endoscopic surgery involves a smaller skin incision. In this study, endoscopic correction of pectus excavatum was performed in 20 cases. A small transverse skin incision was made above the xyphoid process. A wide area beneath the pectoralis major muscle was dissected under endoscopic visualization. Subperichondrial resection was performed under direct visualization when possible. Subperichondrial resection of the third or fourth rib was performed under endoscopic visualization. Ravitch's chondrotomy of the second or third rib was performed under endoscopic visualization. Endoscopy was also useful for sternal elevation, with minimal risk of pleural perforation. Kirschner wire was inserted percutaneously under the sternum to prevent postoperative paradoxical respiration. In all cases, the postoperative course was uneventful. The advantages of endoscopic pectus excavatum correction are a short scar, control of bleeding, safe dissection of the pleura from the sternum without the risk of pleural perforation, and ease of sternal elevation without injury to the intramammary vessels. However, the endoscopic operation is long and is not useful in adults because subperichondrial resection in adults is difficult to perform.

Differenzialdiagnostik manualmedizinischer Syndrome des Thorax und des Abdomens unter Einbeziehung osteopathischer Verfahren

“…Die Operationsergebnisse sind insgesamt mit ü ber 90 % Zufriedenheit gut bis sehr gut [36] . Minimalisierte Verfahren sind auf dem Vormarsch [37,38] .…”

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“…Kamei utilizou técnica semelhante a Ravicth, porém em forma vídeo-assistida através de incisão única subxifóidea e procedeu a ressecção subpericondral da terceira e quarta costela, condrotomia oblíqua da segunda e terceira costela com elevação do esterno e porção proximal das cartilages, osteotomia esternal e, eventualmente, suporte esternal com fio de aço de Kirchner, sendo esta técnica não indicada para adultos 60 .…”

“…Casos graves podem sofrer uma hiper-correção com a cirurgia de Nuss, transformando-os num pectus carinatum 60 . A correção da forma assimétrica com esta técnica não é esteticamente perfeita, embora funcionalmente aceitável quando de grau leve.…”

“…O índice de complicações, apesar da tendência de declínio, tem sido elevado, mesmo no grupo pioneiro e com a maior experiência 6,59,60,62,67,[70][71][72][73] . Complicações graves e que põem em risco a vida tem sido relatadas.…”